Delayed endoscopic retrograde cholangiopancreatography: a game-changer for acute cholangitis patients in a resource-limited setting.

Abstract

Background: Acute cholangitis (AC) is a critical biliary infection caused by gallstones that can progress to systemic inflammation, sepsis, and organ failure. The 2018 Tokyo Guidelines advocate for early endoscopic retrograde cholangiopancreatography (ERCP) in moderate-to-severe AC, but its timing in resource-limited settings remains debated. In Vietnam, where healthcare resources may be limited, the timing of ERCP in patients with AC caused by gallstones has not been extensively studied.

Objectives: To compare outcomes of early ERCP (eERCP, ⩽48 h) versus delayed ERCP (dERCP, >48 h) in managing stone-induced AC.

Design: This was a retrospective cohort study analyzing outcomes of early versus dERCP in 708 patients with stone-induced AC. The study aimed to evaluate procedural efficacy, complications, and long-term outcomes, particularly in a resource-limited setting. Patients were stratified based on ERCP timing (⩽48 h for eERCP and >48 h for dERCP) to enable direct comparisons.

Methods: Data on demographics, clinical features, laboratory findings, and procedural outcomes were analyzed.

Results: The eERCP group exhibited higher rates of severe cholangitis and elevated inflammatory markers compared to the dERCP group. Intensive care unit admission rates were also higher in the eERCP group (3.1% vs 0.8%, p = 0.02). Perforation complications occurred more frequently in the dERCP group (1.2% vs 0%, p = 0.01), while stone treatment outcomes were comparable between the two groups. The eERCP group had a shorter hospital stay (6.5 vs 9.3 days, p < 0.05), although there were no significant differences in readmission or 1-year mortality rates. For patients with severe cholangitis, the treatment outcomes for stones, complications after intervention, and the 1-year mortality and readmission rates are similar between the two groups.

Conclusion: In resource-limited settings, dERCP following resuscitation provides outcomes comparable to eERCP, offering a viable alternative when resources are constrained.