Outcomes of Delayed endoscopic retrograde cholangiopancreatography in acute biliary pancreatitis with cholangitis

Abstract

Introduction: This study aimed to compare the outcomes of early ERCP(≤72 hours) and delayed ERCP(>72 hours) in patients who had acute biliary pancreatitis(ABP) with cholangitis. Method: In this retrospective study, the 95 patients diagnosed with ABP with cholangitis underwent ERCP from May 2012 to April 2018 were reviewed. Result: From the 95 patients, 67(70.5%) patients were classified in an early ERCP group and 28(29.5%) patients in a delayed group. There was no difference pancreatitis severity. The total bilirubin level was higher in the early ERCP group, 5.7±5.2 mg/dL versus 3.5±2.3 mg/dL (p .032), respectively. Patients who had end staged renal disease(ESRD) was lesser in early ERCP group, 0 versus 3(10.7%) (p .006). The patients who took 81mg aspirin was lower in early ERCP group, 15 (22.4%) versus 12(42.9%)(p .044). The mean duration at emergency room before admission was 1.1±1.3 day. The mean duration after admission to ERCP was shorter in early ERCP group, 42.1±18.4 hours versus 152.9±92.4 hours (p <.001). The presence of choledocholithiasis by ERCP was shown no difference between early and delayed ERCP group, 42 (62.7%) versus 18(64.3%) (p .833), respectively. There was no significant difference in mortality rate between early and delayed ERCP groups, 2 (3.0%) versus 0, respectively. There were no differences in disease related complication between early and delayed ERCP groups, 11(16.4%) versus 5 (17.9%) (p .864) and no differences in ERCP related complication, 5(7.5%) versus 3(10.7%) (p .603), respectively. No differences in length of hospital stay(LoS) after ERCP were found. But the total LoS was shorter in early ERCP group, 6.3±4.4 day versus 9.8±6.1 day (p.002). The rate of complete stone removal in early ERCP group was lower, 32(76.2%) versus 18 (100%) (p .023), respectively. Conclusion: Delayed ERCP in ABP with cholangitis could be performed with no differences in term of complication but increased length of hospital stays.