Effect of Delayed Endoscopic Retrograde Cholangiopancreatography after Diagnosis of Acute Cholangitis; A Real-life Experience

Abstract

Objective: Acute cholangitis is a potentially life-threatening condition. Its main treatments include antibiotics and biliary drainage, but longer waiting times for endoscopic biliary drainage may be unavoidable in some limited-resource settings. Materials and Methods: All patients who presented with cholangitis and received ERCP during the 3-year study period were included. The associations between waiting time from the diagnosis of acute cholangitis to the endoscopic drainage and the clinical outcomes, including 30-day all-course mortality and 30-day rehospitalization rates, were compared in patients who received ERCP within 24 hours, 48 hours, 72 hours, 7 days, and later than 7 days. Results: Overall, 300 patients were included. The 30-day all-course mortality rate was 5%, with 9% overall rehospitalization rate, and median waiting time for ERCP of 5 days (1 -50 days). There was no significant difference between 30-day mortality rates in patients who received ERCP within 24 hours, 48 hours, 72 hours and over 7 days (p > 0.05). The mortality rate was significantly higher in those with severe cholangitis and with pancreatobiliary malignancy (p < 0.05). Conclusion: In real life situation when resources are limited, delayed ERCP did not increased the 30-day mortality rate in patients with cholangitis.