Mo1333 THERAPEUTIC ERCP MAY NOT BE NECESSARY FOR ACUTE CHOLANGITIS OR BILIARY COLIC PATIENTS WITH ONLY BILE DUCT SLUDGE ON EUS

Abstract

Recently, there have been several reports on the usefulness of endoscopic ultrasonography (EUS) before endoscopic retrograde cholangiopancreatography (ERCP) for patients with suspected acute cholangitis or biliary colic whose abdominal computed tomography (CT) or transabdominal ultrasonography (TAUS) are negative for biliary stenosis, tumors or stones. However, no sufficient investigations have yet been made on the outcomes of cases that do not have choledocholithiasis but do show only biliary sludge on EUS with conservative follow-up. Among patients that were clinically suspected to have experienced acute cholangitis or biliary colic, and showed negative CT scan and EUS for choledocholithiasis, those who did not undergo therapeutic ERCP and were conservatively followed up were selected. Their outcomes were then examined to reveal whether their clinical outcome including recurrent cholangitis or biliary colic would vary in the presence or absence of biliary sludge. The subjects were extracted from patients who were suspected to have acute cholangitis or biliary colic but were found to have no choledocholithiasis on abdominal CT and EUS in the reporting hospital between April 2012 and July 2017. Among them, 46 cases that did not undergo therapeutic ERCP and were conservatively followed up were examined. These patients were divided into two groups according to the presence or absence of biliary sludge in the common bile duct on EUS findings. A retrospective examination was performed according to the following aspects: the subjects' backgrounds, blood test results, CT findings, EUS findings (the diameter of the common bile duct and the presence or absence of thickening of the common bile duct wall), whether they had undergone cholecystectomy and the date of surgery when performed, and whether they had undergone treatment for subsequent acute cholangitis or biliary colic. Among the 46 cases, 6 (13%) had recurrence during the median follow-up period of 138 days (ranging from 2–1613 days) after undergoing EUS. The median time to recurrence was 31 days (ranging from 3–769 days). Among the 46 patients, 16 (35%) had biliary sludge in the common bile duct on EUS; among 6 cases that had recurrence, only 1 (6%) had biliary sludge. After conservative treatment, cholecystectomy was performed on 7 cases (18%), where 4 (27%) had biliary sludge, and 3 (13%) did not. Among the cases with clinically suspected biliary colic or acute cholangitis, which were negative for choledocholithiasis on CT and EUS and positive for sludge on EUS, acute cholangitis recurred in only 1 case (6%) even after conservative treatment. Though this is a pilot study, the addition of therapeutic ERCP might be considered unnecessary for a patient presenting with only biliary sludge.