Abstract
Acute cholangitis (AC) is often associated with disseminated intravascular coagulation (DIC), and endoscopic transpapillary biliary drainage (EBD) under endoscopic retrograde cholangiopancreatography (ERCP) is a treatment of choice. However, no evidence exists on the outcomes of EBD for AC associated with DIC. Therefore, we retrospectively evaluated the treatment outcomes of early EBD and compared endoscopic biliary stenting (EBS) and endoscopic nasobiliary drainage (ENBD). We included 62 patients who received early EBD (EBS: 30, ENBD: 32) for AC, associated with DIC. The rates of clinical success for AC and DIC resolution at 7 days after EBD were 90.3% and 88.7%, respectively. Mean hospitalization period was 31.7 days, and in-hospital mortality rate was 4.8%. ERCP-related adverse events developed in 3.2% of patients (bleeding in two patients). Comparison between EBS and ENBD groups showed that the ENBD group included patients with more severe cholangitis, and acute physiology and chronic health evaluation II score, systemic inflammatory response syndrome score, and serum bilirubin level were significantly higher in this group. However, no significant difference was observed in clinical outcomes between the two groups; both EBS and ENBD were effective. In conclusion, early EBD is effective and safe for patients with AC associated with DIC.
Highlights
Acute cholangitis (AC) is often associated with disseminated intravascular coagulation (DIC), which can be fatal without prompt and appropriate treatment intervention.Treatment of the primary disease causing DIC remains the most important factor in the resolution of the pathological conditions underlying DIC, and the prognosis of patients with DIC may be markedly affected by the treatment outcome of the primary disease [1].Endoscopic transpapillary biliary drainage (EBD) under endoscopic retrograde cholangiopancreatography (ERCP) is the first choice of treatment for AC [2,3]
Because controlling the primary disease that caused DIC is the most essential treatment for DIC [1,14,15], endoscopic transpapillary biliary drainage (EBD) is the most important treatment for AC associated with DIC
A concern related to EBD for patients with severe AC associated with DIC is poor drainage or clogging in the stent due to the high viscosity of infected bile and hemobilia associated with contact of the device with the bile duct, and no report exists regarding the treatment outcomes of EBD for AC associated with DIC
Summary
Endoscopic transpapillary biliary drainage (EBD) under endoscopic retrograde cholangiopancreatography (ERCP) is the first choice of treatment for AC [2,3]. Endoscopic sphincterotomy (EST) is generally performed before EBD to facilitate insertion of a device into the bile duct or prevention of post-ERCP pancreatitis [4,5]. Bile outflow can be expected through the stent and through the papilla opened by EST. When AC is combined with DIC, EBD without EST is generally required because of the high risk for post-EST bleeding. In severe AC associated with DIC, poor drainage or clogging in the stent due to the high viscosity of infected bile and hemobilia associated with contact of the device with the bile duct is a concern in EBD
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
