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Acute Cholangitis: Does the Timing of ERCP Alter Outcomes?

Harish Patel, Vinaya Gaduputi, Haritha Chelimilla, Jasbir Makker, Hafiz Hashmi, Mahesh Irigela, Anil Dev, Sridhar Chilimuri

Introduction Ascending cholangitis is a life threatening condition whose treatment includes fluid resuscitation, antibiotic therapy and definitive decompression of biliary tree. Timing of endoscopic retrograde cholangiopancreatography can be influenced by multiple factors including resuscitation period and coagulation abnormalities. This in turn can affect outcomes such as mortality and length of stay. Methods Patients who underwent endoscopic retrograde cholangiopancreatography for cholangitis between January 2009 and August 2012 were included in the study. Patients were grouped into one of the three study groups based on timing endoscopic retrograde cholangiopancreatography - patients who underwent endoscopic retrograde cholangiopancreatography within 24 hours, between 24 to 48 hours, and beyond 48 hours. Outcome measures of mortality and length of stay were observed in the three groups. Results A total 69 patients were included in the study. The mean age of the study population was 54 years (20±SD). 68% (n= 47) and 16% (n=11) of the study population were of Hispanic and African American ethnicities respectively. 68% (n=46) had grade-I severity of cholangitis, 19% (n=13) had grade-II severity and 13% (n=10) had grade–III severity. Timing of endoscopic retrograde cholangiopancreatography was as follows: within 24 hours in 33% (n=23), between 24 hours and 48 hours in 18% (n=12), and beyond 48 hours in 49% (n=34). The all cause in hospital mortality for patients with acute cholangitis include in this study was 11% (n=8). Mortality did not correlate with the timing of endoscopic retrograde cholangiopancreatography. There was difference in the lengths of hospital stay- 7 days for endoscopic retrograde cholangiopancreatography within 24 hours group, 6 days for 24 to 48 hours group and 14 days for beyond 48 hours group. Conclusion Therapeutic endoscopic retrograde cholangiopancreatography must be expediently pursued in all cases of acute cholangitis whenever feasible. However, we observed that timing of endoscopic retrograde cholangiopancreatography in cholangitis did not correlate with mortality but did significantly influence the length of stay.