Sa1515 Efficacy of Wire-Guided Cannulation of the Bile Duct in the Treatment of Acute Cholangitis

Abstract

Rapid biliary decompression is important in the treatment of acute cholangitis. Because of nonuse of contrast medium injection, wire-guided cannulation (WGC) is considered to avoid enlarging intrabiliary pressure. WGC during endoscopic biliary drainage might reduce the duration of acute cholangitis compared to standard cannulation (SC). We retrospectively analyzed patients with acute cholangitis underwent urgent biliary drainage using WGC or SC successfully. Patients with normal body temperature, acute pancreatitis, hepatic abscess, hilar biliary obstruction, and biliary metallic stent, whose distal end was in the duodenum, were excluded. The duration of fever, the time of procedure, and complications were compared between both cannulation methods. The timing of injection of contrast medium was: after fully aspiration of bile juice in WGC, before aspiration in SC. Severity of cholangitis was based on Tokyo Guideline. Either endoscopic nasobiliary drainage (ENBD) tube or plastic stent (PS) was used as drainage device. Eighty-three patients (32 in WGC, 51 in SC) were eligible between April 2007 and April 2010. The baseline characteristics did not show significant differences in following parameters: median age, 77y vs. 76y; male, 66% vs. 49%; causative diseases (common bile duct stone, 25 vs. 40; cholangiocarcinoma, 4 vs. 6; pancreatic cancer, 2 vs. 3; hepatocellular carcinoma, 1 vs. 1; and chronic pancreatitis, 0 vs. 1); severity (mild, 7 vs. 8; moderate, 19 vs. 27; and severe, 6 vs. 16); and diabetes mellitus, 8 vs. 10. There was significant difference in ASA score (1/2/3/4, 2/17/13/0 vs. 10/32/8/1, P = 0.03). There was no significant differences in drainage devices (ENBD/PS, 28/4 vs. 46/5). The duration of fever was significantly shorter in WGC than SC (1 day [interquartile range, 1-2.75] vs. 2 days [2-4], P = 0.01). The median time of procedure (16.5min. vs. 25min.), post-ERCP pancreatitis (0% vs. 5.9%), and hyperamylasemia (15.6% vs. 21.6%) were not significantly different, but WGC exceeded SC in all these subjects. Subset analysis of the duration of fever according to severity revealed significant difference in severe group (1 [1-4] vs. 3.5 [2-4.75], P = 0.048), but no significant difference in mild (2 [1-3] vs. 1.5 [1-2.75]) and moderate group (1 [1-2] vs. 2 [1-3]). WGC during endoscopic biliary drainage reduced the duration of acute cholangitis compared to SC, especially in severe cases.