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No Association of Timing of Endoscopic Biliary Drainage with Clinical Outcomes in Patients with Non-severe Acute Cholangitis

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Abstract

Background

Biliary drainage via endoscopic retrograde cholangiopancreatography (ERCP) is the first-line treatment for acute cholangitis. Despite the established effectiveness of urgent biliary drainage in patients with severe acute cholangitis, the indication of this procedure for non-severe acute cholangitis is controversial.

Aims

To assess the safety of elective drainage (≥ 12 h of admission) for non-severe acute cholangitis.

Methods

We retrospectively identified 461 patients with non-severe acute cholangitis who underwent endoscopic biliary drainage. Using linear regression models with adjustment for a variety of potential confounders, we compared elective versus urgent biliary drainage (< 12 h of admission) in terms of clinical outcomes. The primary outcome was the length of stay.

Results

There were 98 and 201 patients who underwent elective and urgent biliary drainage, respectively. The median length of stay was 11 days in both groups (P = 0.52). The timing of ERCP was not associated with length of stay in the multivariable model (P = 0.52). Secondary outcomes including in-hospital mortality and recurrence of cholangitis were not different between the groups.

Conclusions

Elective biliary drainage was not associated with worse clinical outcomes of non-severe acute cholangitis as compared to urgent drainage. Further investigation is warranted to justify the elective drainage for non-severe cholangitis.

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Author information

Author notes

  1. Ryunosuke Hakuta and Tsuyoshi Hamada contributed equally as co-first authors.

Authors and Affiliations

  1. Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Ryunosuke Hakuta, Tsuyoshi Hamada, Yousuke Nakai, Hirofumi Kogure, Rie Uchino, Naminatsu Takahara, Suguru Mizuno, Tatsunori Suzuki, Tatsuya Sato, Tsuyoshi Takeda, Kazunaga Ishigaki, Kei Saito, Tomotaka Saito, Minoru Tada, Hiroyuki Isayama & Kazuhiko Koike

  2. Department of Oncologic Pathology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA

    Tsuyoshi Hamada

  3. Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan

    Hiroyuki Isayama

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  1. Ryunosuke Hakuta
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  2. Tsuyoshi Hamada
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Contributions

RH, TH, and YN contributed to conception and design of the study, analysis and interpretation of the data, and drafting of the article. HK, RU, NT, SM, TS, TS, TT, KI, KS, TS, MT, HI, YN, and KK contributed to critical revision of the article for important intellectual content. All authors contributed to the final approval of the article.

Corresponding author

Correspondence to Yousuke Nakai.

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The authors declare that they have no conflict of interest.

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Hakuta, R., Hamada, T., Nakai, Y. et al. No Association of Timing of Endoscopic Biliary Drainage with Clinical Outcomes in Patients with Non-severe Acute Cholangitis. Dig Dis Sci 63, 1937–1945 (2018). https://doi.org/10.1007/s10620-018-5058-8

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  • DOI: https://doi.org/10.1007/s10620-018-5058-8

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