Endoscopic Retrograde Cholangiopancreatography In Patients Research Articles

Dexmedetomidine or midazolam in combination with propofol for sedation in endoscopic retrograde cholangiopancreatography: a randomized double blind prospective study.

IntroductionInterventional endoscopic procedures, such as endoscopic retrograde cholangiopancreatography (ERCP), often require sedation during the procedure. The most commonly used drugs for this purpose are midazolam and propofol, which are used as sedative and hypnotic agents with minimal analgesic potential.AimTo compare the analgesic sedative effects of midazolam-propofol and dexmedetomidine-propofol combinations and their influence on hemodynamic and respiratory variables in patients undergoing ERCP.Material and methodsForty adult patients aged 20-78 and undergoing ERCP were randomized to two groups. Patients were premedicated with midazolam (0.05 mg/kg 10 min before the procedure) in group M and with dexmedetomidine (1 μg/kg for 10 min) in group D. Propofol was used for maintenance. The sedation level was monitored using the bispectral index (BIS) to maintain a score between 70 and 80. Hemodynamic and respiratory variables, recovery time and adverse events were recorded.ResultsThe hemodynamic and respiratory variables were similar in both groups. Total propofol consumption was significantly lower in the dexmedetomidine group (208.5 ±80.0 vs. 154.5 ±66.7 mg; p = 0.011). The recovery period was shorter in group D (time to achieve the Aldrete score 9 was 9.4 ±2.1 vs. 6.6 ±1.1 min; p < 0.001). Changes in hemodynamic and respiratory variables and adverse events were not different between the two groups.ConclusionsWe found a shorter recovery time and comparable sedative and adverse effects with the dexmedetomidine-propofol combination compared with the midazolam-propofol combination. Dexmedetomidine in combination with propofol may be a safe and useful alternative for sedation for ERCP patients.

Endoscopic Retrograde Cholangiopancreatography in Patients With Surgically Altered Anatomy

This review describes the recent advances and evolving techniques in endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy (SAA) and highlights the novel alternative approaches for pancreato-biliary interventions in this group of patients. The limitations of ERCP in patients with SAA have led to the development of improved endoscopic devices and accessories, and alternative approaches for pancreato-biliary interventions. Dedicated short-type single and double balloon enteroscopes (BE) have been developed with increased maneuverability and larger accessory channels that enhance scope insertion and allow the use of various ERCP devices, respectively. In failed BE-ERCP cases, endoscopic ultrasound-guided biliary drainage (EUS-BD) has been used to gain access to the pancreato-biliary system, with high reported procedural success. More recently, lumen-apposing metal stent (LAMS) has been used to create a temporary bridge to the excluded stomach in Roux-en-Y gastric bypass (RYGB), and the small bowel loop in other altered GI anatomy, through which conventional ERCP can be performed, with excellent preliminary results. Several novel approaches and techniques are developed and being evaluated for pancreato-biliary intervention in patients with SAA. The optimal approach should be considered based on patient history, institutional factors, and multidisciplinary collaboration.

Evaluación del dolor y distensión abdominal según agente insuflante (CO₂ versus aire) en una unidad de endoscopia digestiva avanzada en Manizales, Colombia.

Objetivo: comparar la magnitud del dolor y el perímetro abdominal; la incidencia del dolor y la distensión abdominal, y las complicaciones según el agente insuflante utilizado.&#x0D; Pacientes y método: estudio prospectivo analítico de cohorte. Se recolectaron datos de 43 colangiopancreatografías retrógradas endoscópicas (CPRE) y 20 colonoscopias insufladas con dióxido de carbono (CO2); para cada una se buscó un examen control con aire ambiente. En total, se sumaron 86 CPRE y 40 colonoscopias. Además, se realizó una caracterización clínica, un análisis bivariado y multivariado.&#x0D; Resultados: el procedimiento más doloroso fue la colonoscopia; sin embargo, el 60 % de los pacientes de colonoscopia, y el 70 % de aquellos de CPRE, no presentaron dolor 15 minutos después de haber despertado luego del examen. Asimismo, no se hallaron diferencias estadísticamente significativas según la indicación del examen, la presencia o intensidad de dolor al momento del procedimiento, la edad, el sexo o el diagnóstico. El riesgo relativo (RR) de dolor inmediato fue 4,8 veces superior, cuando la insuflación se realizó con aire en vez de CO2 (RR = 4,8; intervalo de confianza [IC], 95 %: 2,3 a 9,2; p &lt;0,001). Entre tanto, el riesgo de distensión abdominal en el grupo con aire fue 2,6 veces superior, en comparación con el grupo insuflado con CO2 (RR = 2,6; IC, 95 %: 1,8 a 3,9; p &lt;0,001). El CO2 redujo la probabilidad y la magnitud de la distensión abdominal y del dolor inmediatos, posteriores a la colonoscopia o a la CPRE. No hubo complicaciones en ninguno de los 126 pacientes.&#x0D; Conclusiones: el dolor y la distensión abdominal se presentan con menor frecuencia e intensidad cuando se usa CO2 como agente insuflante. Ninguno de los procedimientos presentó complicaciones mayores.

Double-balloon endoscopic retrograde cholangiopancreatography for patients who underwent liver operation: A retrospective study.

BACKGROUNDDouble-balloon endoscopic retrograde cholangiography (DB-ERC) is widely performed for biliary diseases after reconstruction in gastrointestinal surgery, but there are few reports on DB-ERC after hepatectomy or living donor liver transplantation (LDLT).AIMTo examine the success rates and safety of DB-ERC after hepatectomy or LDLT.METHODSThe study was performed retrospectively in 26 patients (45 procedures) who underwent hepatectomy or LDLT (liver operation: LO group) and 40 control patients (59 procedures) who underwent pancreatoduodenectomy (control group). The technical success (endoscope reaching the choledochojejunostomy site), diagnostic success (performance of cholangiography), therapeutic success (completed interventions) and overall success rates, insertion and procedure (completion of DB-ERC) time, and adverse events were compared between these groups.RESULTSThere were no significant differences between LO and control groups in the technical [93.3% (42/45) vs 96.6% (57/59), P = 0.439], diagnostic [83.3% (35/42) vs 83.6% (46/55), P = 0.968], therapeutic [97.0% (32/33) vs 97.7% (43/44), P = 0.836], and overall [75.6% (34/45) vs 79.7% (47/59), P = 0.617] success rates. The median insertion time (22 vs 14 min, P < 0.001) and procedure time (43.5 vs 30 min, P = 0.033) were significantly longer in the LO group. The incidence of adverse events showed no significant difference [11.1% (5/45) vs 6.8% (4/59), P = 0.670].CONCLUSIONDB-ERC after liver operation is safe and useful but longer time is required, so should be performed with particular care.

Diagnostic performance of different cholangioscopes in patients with biliary strictures: a systematic review.

Cholangioscopy provides direct intraductual imaging, which can enhance diagnostic efficacy during endoscopic retrograde cholangiopancreatography in patients with biliary strictures. This study aimed to review the diagnostic yield of different cholangioscopes for the diagnosis of malignant biliary stricture (MBS). A comprehensive literature review was performed. Full papers of prospective studies using any type of peroral cholangioscope (POC) were included without language restriction. The primary outcomes were sensitivity, specificity, and accuracy of various POCs to diagnose MBS. Data from 20 published articles, involving 1141 patients, were extracted. Overall sensitivities of POCs for diagnosing MBS were higher for the diagnosis made under visual impression compared with those from cholangioscopy-guided biopsy (67 % - 100 % vs. 38 % - 100 %), whereas the overall specificities were generally high and comparable (73 % - 100 % vs. 75 % - 100 %). Newer video cholangioscopes (digital single-operator POC [digital SOC], direct POC) with the exception of video dual-operator mother - baby POC (video DOC), provided better sensitivity of cholangioscopy-guided biopsy compared with fiberoptic scopes (digital SOC 80 % - 85 %, direct POC 80 % - 100 %, video DOC 38 % - 100 %, and fiberoptic SOC 49 % - 100 %, respectively). Among these video cholangioscopes, the digital SOC provided the highest technical success rate, at 100 %. POCs enhanced the diagnostic yield for diagnosis of MBS. Compared with fiberoptic POCs that only provide good image impression, the digital SOC and direct POC were good at both image impression and cholangioscopy-guided biopsy to diagnose MBS. To ensure high technical success for MBS diagnosis, the digital SOC is a good option.

Outcomes of delayed endoscopic retrograde cholangiopancreatography in patients with acute biliary pancreatitis with cholangitis

ObjectiveThe recommended treatment for acute biliary pancreatitis(ABP) with cholangitis is urgent endoscopic retrograde cholangiopancreatography(ERCP). However, tight schedules in the endoscopy room mean that urgent ERCP may not always be performed. This study aimed to compare the outcomes of early (≤72 h) and delayed(>72 h) ERCP in patients with ABP with cholangitis. MethodsNinety-five patients diagnosed with ABP with cholangitis who underwent ERCP between May 2012 and April 2018 were retrospectively reviewed. ResultsSixty-seven patients(70.5%) were classified in the early ERCP and 28(29.5%) in the delayed ERCP groups. There was no significant difference in pancreatitis severity between the groups. Total bilirubin was higher in the early compared with the late ERCP group (5.7 ± 5.2 versus 3.5 ± 2.3 mg/dL, p = 0.03). Fewer patients in the early group had end-stage renal disease (0 versus 3, p = 0.006) and relatively fewer patients in the early group took aspirin (15(22.4%) versus 12(42.9%), p = 0.04). There were no significant differences between the early and delayed ERCP groups in terms of mortality (2(3.0%) versus 0), disease-related complications(11 (16.4%) versus 5(17.9%), p = 0.86), or ERCP-related complications(5(7.5%) versus 3(10.7%), p = 0.60). The total length of stay(LoS) was shorter in the early group(6.3 ± 4.4 versus 9.8 ± 6.1 days, p = 0.002). The rate of complete stone removal was lower in the early compared with the delayed ERCP group(32/42(76.2%) versus 18/18(100%), p = 0.02). ConclusionDelayed ERCP can be performed in selected patients with ABP with cholangitis, with similar complication rates but longer LoS compared with early ERCP.

Endoscopic retrograde cholangiopancreatography in patients with periampullary diverticula: Technical details, classification, and timing of surgical treatment

Endoscopic retrograde cholangiopancreatography in patients with periampullary diverticula: Technical details, classification, and timing of surgical treatment

Challenges of endoscopic retrograde cholangiopancreatography in patients with Billroth II gastrointestinal anatomy: A review article.

Endoscopic retrograde cholangiopancreatography (ERCP) is a combination of endoscopy and fluoroscopy that is commonly used in the management of pancreatobiliary diseases. ERCP can be challenging if performed in surgically altered anatomy, such as a Billroth II reconstruction, compared with native anatomy and usually has a lower success rate. We identified five emerging challenges in such patients. These are the choice of endoscope, the identification of afferent loop, reaching the duodenal stump, cannulation in the reverse position, and endoscopic sphincterotomy. Performing ERCP in patients with a Billroth II reconstruction needs adequate knowledge, proper skill, and experience to achieve a good clinical outcome.

Endoscopic Retrograde Cholangiopancreatography in Patients With Roux-en-Y Gastric Bypass.

Endoscopic Retrograde Cholangiopancreatography in Patients With Roux-en-Y Gastric Bypass.

924 How Successful Is Endoscopic Retrograde Cholangiopancreatography in Patients With Biliary Obstruction Post-Pancreaticoduodenectomy?

INTRODUCTION: Endoscopic retrograde cholangiopancreatography (ERCP) is the accepted therapy for the management of biliary obstructions, however, in patients who have had previous pancreaticoduodenectomy (PD) (i.e. Whipple’s procedure), due to the altered surgical anatomy, the ability to perform ERCP is challenging. In this study, we examine our experience at a large tertiary cancer-center in performing ERCPs for biliary obstructions in patients who are post-PD. METHODS: This was a retrospective review from 2006 to 2018 of all patients referred for the management of biliary obstructions post-PD. Outcomes included technical success (ability to treat the stricture, e.g. dilation or placement of a stent) and clinical success (decrease in bilirubin to normal or 50% of peak value within 2 weeks) rates. RESULTS: A total of 66 patients were included in the study. The mean age was 67.7 years (SD +/- 11.6) and 58 patients (87.9%) were male. The most common indications for PD were duodenal adenocarcinoma (20 patients, 30.3%) followed by pancreatic adenocarcinoma (16, 24.4%). In terms of surgery, the mean length of the afferent limb was 45.7 cm (SD +/- 6.34). The most common indications for ERCP were cholangitis (31 patients, 49%), followed by a biliary obstruction without cholangitis (11, 16.7%). The mean length of procedure was 66.7 minutes (SD +/- 34.8). The hepaticojejunostomy (and/or choledochojejunostomy) was reached in 56 patients (84.8%). The most common endoscope used was a therapeutic upper endoscope (31 patients, 47%), followed by a regular upper endoscope (11, 16.7%) and a pediatric colonoscope (10, 15.2%). Cannulation of the biliary tree was successful in 55 patients (83.3%). The most common location for the stricture was at the anastomosis (41 patients, 80.4%), followed by distal extra-hepatic (8, 15.7%). Successful stents were placed in 31 patients (47%). There were no episodes of bleeding, perforation or pancreatitis post-ERCP. Four patients developed self-resolving fever post-procedure. The technical success rate was 75.8% (50 patients) while the clinical success rate was 71.2% (47 patients). CONCLUSION: ERCP post-PD can be challenging due to the surgical anatomy and inability to use common endoscopes and instruments. Our study demonstrates that nevertheless, endoscopic biliary decompression can still be successful by experienced endoscopists in the majority of patients post-PD, with minimal adverse events.

Application of single balloon enteroscopy-assisted therapeutic endoscopic retrograde cholangiopancreatography in patients after bilioenteric Roux-en-Y anastomosis: Experience of multi-disciplinary collaboration.

BACKGROUNDBilioenteric Roux-en-Y anastomosis is one of the most complicated approaches for reconstructing the gastrointestinal tract, and endoscopic retrograde cholangiopancreatography (ERCP) is technically challenging in patients after bilioenteric Roux-en-Y anastomosis. The optimal endoscopic strategies for such cases remain unknown.AIMTo explore the feasibility and effectiveness of single balloon enteroscopy-assisted (SBE-assisted) therapeutic ERCP in patients after bilioenteric Roux-en-Y anastomosis based on multi-disciplinary collaboration between endoscopists and surgeons as well as report the experience from China.METHODSThis is a single center retrospective study. All of the SBE-assisted therapeutic ERCP procedures were performed by the collaboration between endoscopists and surgeons. The operation time, success rate, and complication rate were calculated.RESULTSForty-six patients received a total of 64 SBE-assisted therapeutic ERCP procedures, with successful scope intubation in 60 (93.8%) cases and successful diagnosis in 59 (92.2%). All successfully diagnosed cases received successful therapy. None of the cases had perforation or bleeding during or after operation, and no post-ERCP pancreatitis occurred.CONCLUSIONBased on multi-disciplinary collaboration, SBE-assisted therapeutic ERCP in patients after bilioenteric Roux-en-Y anastomosis is relatively safe and effective and has a high success rate.

Application of multimedia health education in patients with endoscopic retrograde cholangio-pancreatography minimally invasive treatment

Objective To evaluate the effect of mobile nursing workstation multimedia module applied to preoperative health education of patients with minimally invasive endoscopic retrograde cholangiopancreatography (ERCP) . Methods By convenience sampling, 100 patients who met the inclusion criteria in-hospitalized in Department of Digestive Medicine, Beijing Chao-Yang Hospital, Capital Medical University from January to June of 2018 were selected and divided into the observation group (n=44) and control group (n=44) according to the random number table. Conventional education approach of oral teaching and distribution of teaching materials was adopted in the control group, besides of that the observation group received the intensive teaching approach through mobile nursing platform multimedia and open communication. The knowledge mastering status, satisfactory degree and anxiety scores were compared between the two groups after health education. Results In the observation group, the score of knowledge mastering status was (33.00±9.41) , satisfactory degree was (23.45±1.18) , both higher than the control group [ (28.82±7.48) , (17.61±1.95) ] with statistical difference (P<0.05) ; the observation group achieved lower score in anxiety than the control group with statistical difference (P<0.01) . Conclusion The use of mobile nursing platform multimedia teaching method can improve the quality of health education for patients with minimally invasive ERCP treatment and patient satisfaction, alleviate the anxiety of patients. Key words: Health education; Endoscopic retrograde cholangiopancreatography; Minimally invasive treatment; Multimedia

Burdens of Postoperative Infection in Endoscopic Retrograde Cholangiopancreatography Inpatients

ObjectivesOur objective in this study is, firstly, to determine postoperative (POI) rates in endoscopic retrograde cholangiopancreatography (ERCP) procedures stratified by patients’ demographic and hospitals’ characteristics in the United States, and secondly, to evaluate the demographic and comorbid risk factors associated with POI in ERCP inpatients, as well as its impact on the length of stay (LOS) and total charges.MethodsThe total sample of 28,525 inpatients with a principal procedure of ERCP from the Nationwide Inpatient Sample (NIS) was included and grouped by co-diagnosis of POI (N=300, 1.05%). We used a logistic regression model and descriptive statistics for the POI rate estimates.ResultsHigh POI rate was seen in males (1.14%), and adults (36-50 years, 1.25%) with 2.65 times (95% CI 1.69-4.12) higher odds compared to young adults. POI rate in ERCP inpatients varied widely according to geographic region: higher in the West (1.46%) and Northeast (1.20%) and lowest in the Midwest (0.70%). As per the hospital characteristics, inpatients in public (1.26%), urban teaching (1.39%) and small bed-size (1.27%) hospitals had higher POI rates. ERCP inpatients with POI had higher odds of association with comorbid HIV infection (OR 1.55, 95% CI 1.13-2.12) and diabetes (OR 1.43, 95% CI 1.09-1.85). ERCP inpatients with POI had a significantly longer length of stay (LOS) by 5.2 days and higher total charges by USD 53,966 than inpatients without POI.ConclusionsPOI is associated with acute inpatient care, with longer hospitalization stays and higher costs, leading to increased healthcare burdens. The main goal is to identify the risk factors and to prevent POI with prophylactic antibiotics.

Current status of endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy

Endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy must be performed by a highly experienced endoscopist. The challenges are accessing the afferent limb in different types of reconstruction, cannulating a papilla with a reverse orientation, and performing therapeutic interventions with uncommon endoscopic accessories. The development of endoscopic techniques has led to higher success rates in this group of patients. Device-assisted ERCP is the endoscopic procedure of choice for high success rates in short-limb reconstruction; however, these success rate is lower in long-limb reconstruction. ERCP assisted by endoscopic ultrasonography is now popular because it can be performed independent of the limb length; however, it must be performed by a highly experienced and skilled endoscopist. Stent deployment and small stone removal can be performed immediately after ERCP assisted by endoscopic ultrasonography, but the second session is needed for other difficult procedures such as cholangioscopy-guided electrohydraulic lithotripsy. Laparoscopic-assisted ERCP has an almost 100% success rate in long-limb reconstruction because of the use of a conventional side-view duodenoscope, which is compatible with standard accessories. This requires cooperation between the surgeon and endoscopist and is suitable in urgent situations requiring concomitant cholecystectomy. This review focuses on the advantages, disadvantages, and outcomes of various procedures that are suitable in different situations and reconstruction types. Emerging new techniques and their outcomes are also discussed.

Low Serum Trypsin Levels Predict Deep Pancreatic Cannulation Failure During Endoscopic Retrograde Cholangiopancreatography in Patients With Symptomatic Obstructive Chronic Pancreatitis

Deep pancreatic cannulation (DPC) failure during endoscopic retrograde cholangiopancreatography (ERCP) in patients with chronic pancreatitis (CP) can occur in the presence of ductal obstruction due to strictures and/or stones. There are currently no simple preprocedure clinical or laboratory tests that can predict DPC failure during ERCP. All adult patients with definite CP by M-ANNHEIM criteria referred to the pancreatitis clinic between 2010 and 2017 were evaluated. Serum trypsin levels were obtained to assess the morphologic severity of disease and/or exocrine insufficiency. Univariable and multivariable logistic regression analyses were performed to identify factors associated with DPC failure. There were 346 patients, of whom 100 underwent trypsin measurements and ERCP for symptomatic CP. Deep pancreatic cannulation failure occurred in 32 (32%). There were no significant differences with regard to age, sex, etiology, smoking, and alcohol use. Deep pancreatic cannulation failure was more likely to occur in patients with low trypsin levels (53.1% vs 25%, P = 0.007) compared with those with successful DPC. Low trypsin levels were independently associated with DPC failure in adjusted analysis (odds ratio, 3.7; 95% confidence interval, 1.2-11; P = 0.02). Low serum trypsin levels independently predict DPC failure during ERCP in patients with symptomatic obstructive CP.

Sa1020 – Racial Disparities in Time from Admission to Endoscopic Retrograde Cholangiopancreatography for Patients Diagnosed with Acute Cholangitis

Sa1020 – Racial Disparities in Time from Admission to Endoscopic Retrograde Cholangiopancreatography for Patients Diagnosed with Acute Cholangitis

Modern concepts of sphincter of Oddi pancreatic dysfunction

History of study of the sphincter of Oddi (SO) is presented in a detail in the article, attention is paid to the anatomical and functional relationships of SO with the gallbladder, duodenum and pancreas. The role of SO dysfunction in the pathogenesis of pancreatitis and biliary dysfunction is described in detail, previous and modern ideas about SO pancreatic disfunction are considered. The historical features of the introduction of the term “dyspancreatism” are given, the clinical peculiarities and periods of its occurrence are listed, the pathogenetic relationship of dyspancreatism with other functional disorders, including functional dyspepsia, is described. Provisions of the IV Roman consensus are considered, confirming the relationship of pancreatic dysfunction with the occurrence of pancreatic pain and pancreatitis itself. The criteria for the diagnostics of pancreatic type SO dysfunction, formulated in the modern Rome recommendations for the diagnosis and treatment of functional gastroenterological disorders, are presented. Standard and alternative diagnostic tests are listed, which conduction will confirm the SO dysfunction. Modern approaches to the treatment of SO dysfunction are analyzed, focusing on the use of invasive treatment methods, the advantages and disadvantages of biliary and pancreatic sphincterotomy are revealed, the inexpediency of performing the endoscopic retrograde cholangiopancreatography in patients with single episode of idiopathic acute pancreatitis is proved. The need for a balanced and cautious approach to the use of invasive methods for the treatment of SO dysfunction is emphasized; prospects for further study of the pathology of this sphincter are described.

Endoscopic Retrograde Cholangiopancreatography Findings Differs From Ultrasound Results: A Study On Choledocholitihisis Patients In A Tertiary Care Hospital Of Bangladesh

Background: Endoscopic retrograde cholangio-pancreatography (ERCP) is a universally established modality in evaluation and treatment of pancreatico-biliary disorders. Choledocholothiasis is one of its common indications. In the context of Bangladesh, clinical studies on ERCP, specially, assessment of the role of pre-procedural Ultrasound as a screening tool, is relatively rare. In this work, we have analyzed the ERCP outcome of 95 patients and compared their pre-procedural ultrasound results afterwards.&#x0D; Methods: This cross-sectional observational study was conducted in the BIRDEM General Hospital during June 2013 to January2015 on 95 ERCP patients. Among 95 patients, maximum (27.7%) were diagnosed as Choledocholithiasis. The important diagnosis among the rest were, Chronic Calcific Pancreatitis (13.8%), Ca head of Pancreas (12.7%), Cholangiocarcinoma (11.7%), and peri- ampullary carcinoma (11.7%). Ultrasound could not detect common bile duct stone in 42% of choledocholithiasis patients. It detected dilated common bile duct in 30% patients and 15% patients had normal ultrasound report while they underwent ERCP due to high clinical suspicion and found to have duct stone afterwards.&#x0D; Conclusion: The role of ultrasound as a screening test for choledocholithiasis should be progressively assessed by comparing it with MRCP and ERCP results. This study will encourage further research to find correlation between the ERCP and Imaging (both ultrasound and MRCP) in choledocholithiasis patients&#x0D; Bangladesh J Medicine Jan 2019; 30(1) : 5-8

Early vs late endoscopic retrograde cholangiopancreatography in patients with acute cholangitis: A nationwide analysis.

AIMTo assess the effect of early vs late endoscopic retrograde cholangiopancreatography (ERCP) on mortality and readmissions in acute cholangitis, using a nationally representative sample.METHODSWe used the 2014 National Readmissions Database to identify adult patients hospitalized with acute cholangitis who underwent therapeutic ERCP within one week of admission. Early ERCP was defined as ERCP performed on the same day of admission or the next day (days 0 or 1, < 48 h), and late ERCP was performed on days 2 to 7 of admission. Patients with severe cholangitis had any of the following additional diagnoses: Severe sepsis, septic shock, acute renal failure, acute respiratory failure, or thrombocytopenia. Multivariate logistic regression was used to calculate the adjusted odds of association of ERCP timing with in-hospital mortality, 30-d mortality, and 30-d readmissions, controlling for age, sex, severe disease and comorbidities.RESULTSFour thousand five hundred and seventy patients satisfied the inclusion criteria; with a mean age of 64.1 years. Of these, 66.6% had early ERCP, while 33.4% had late ERCP. Early ERCP was associated with lower in-hospital mortality [1.2% vs 2.4%, adjusted odds ratio (aOR) = 0.50, 95%CI: 0.76-0.83, P = 0.001] and lower 30-d mortality (1.5% vs 3.3%, aOR = 0.48, 95%CI: 0.33-0.69, P < 0.0001) compared to the late ERCP group. Similarly, early ERCP was associated with lower 30-d readmissions (9.7% vs 15.1%, aOR = 0.58, 95%CI: 0.49-0.7, P < 0.0001). When stratified by severity of cholangitis, there was a similar benefit of early ERCP on all outcomes in those with and without severe cholangitis. The mean length of stay was higher in the late ERCP group compared to the early ERCP group (6.9 d vs 4.5 d, P < 0.0001). The mean hospitalization cost was higher in the late ERCP group ($21459 vs $16939, P < 0.0001).CONCLUSIONEarly ERCP is associated with lower in-hospital and 30-d mortality in those with or without severe cholangitis. Regardless of severity, we suggest performing early ERCP.

Efficacy and safety of therapeutic endoscopic retrograde cholangiopancreatography in patients with native papillae with a performance status score of 3 or 4: A single-center retrospective study.

Objective: This study aimed to assess the efficacy and safety of therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in patients with an Eastern Cooperative Oncology Group performance status (ECOG-PS) score of 3 or 4.Patients and Methods: We reviewed the data of 287 patients with native papillae who underwent therapeutic ERCP for biliary disease at our hospital between October 2016 and October 2018. The patients were divided into two groups; those with an ECOG-PS score of 3 or 4 (group A; n=78) and those with an ECOG-PS score of 0–2 (group B; n=209).Results: The rate of technical success was not significantly different between the two groups (95% versus 89%, P=0.13). Although the occurrence rate of overall adverse events (10% versus 11%, P=0.95) was not significantly different between the groups, the occurrence rates of aspiration pneumonia (3.8% versus 0%, P=0.0044) and heart failure (2.6% versus 0%, P=0.020) were significantly higher in group A.Conclusion: The rates of technical success and overall adverse events did not significantly differ between patients with an ECOG-PS score of 3 or 4 and those with a score of 0–2; however, aspiration pneumonia and heart failure were more likely to occur among patients with an ECOG-PS score of 3 or 4.