Early and Direct Endoscopic Stone Removal in the Moderate Grade of Acute Cholangitis with Choledocholithiasis Was Safe and Effective: A Prospective Study

• Published in: Life (Basel, Switzerland) Vol. 12; no. 12; p. 2000
• Main Authors: Liang, Chih-Ming, Chiu, Yi-Chun, Lu, Lung-Sheng, Wu, Cheng-Kun, Sou, Fai-Meng, Chiu, Shao-Ming, Lee, Yu-Chi, Huang, Pao-Yuan, Chuah, Seng-Kee, Kuo, Chung-Mou
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 30-11-2022; MDPI
• Subjects: Bile; Care and treatment; Catheters; cholangiopancreatography; Cholangitis; Emergency medical care; endoscopic papillary balloon dilation; Endoscopic retrograde cholangiopancreatography; endoscopic retrograde endoscopic sphincterotomy; Endoscopy; Gallstones; Medical treatment; Methods; Mortality; Multivariate analysis; Pancreatitis; Patient outcomes; Patients; post-endoscopic retrograde cholangiopancreatography pancreatitis; Regression analysis; Success; Taiwan; United States > US; Japan; Germany; endoscopic retrograde endoscopic sphincterotomy; cholangiopancreatography; endoscopic papillary balloon dilation; post-endoscopic retrograde cholangiopancreatography pancreatitis
• ISSN: 2075-1729; 2075-1729
• DOI: 10.3390/life12122000

Evidence supporting the feasibility of single-stage stone removal in patients with a moderate grade of acute cholangitis remains insufficient. The maximal size of a common bile-duct stone suitable for removal during a single-stage ERCP in a moderate grade of acute cholangitis is unknown.
We prospectively enrolled 196 endoscopic retrograde cholangiopancreatography (ERCP)-naïve patients diagnosed with acute cholangitis and choledocholithiasis. For eligible patients, single-stage treatment involved stone removal at initial ERCP.
A total of 123 patients were included in the final analysis. The success rate of complete stone extraction was similar between patients with mild and moderate grades of acute cholangitis (89.2% vs. 95.9%;
= 0. 181). Complication rates were comparable between the two groups. In the moderate grade of the cholangitis group, among patients who underwent early single-stage ERCP, the length of hospitalization declined as short as the patients in the mild grade of cholangitis (10.6 ± 6.2 vs. 10.1 ± 5.1 days;
= 0.408). In the multivariate analysis, early ERCP indicated shorter hospitalization times (≤10 days) (odds ratio (OR), 3.981;
= 0.001). A stone size less than 1.5 cm presented a high success rate (98.0%) for complete stone removal.
Single-stage retrograde endoscopic stone removal in mild and moderate grades of acute cholangitis may be safe and effective, which can obviate the requirement for a second session, thus reducing medical expenses.
gov: NCT03754491.