ERCP delay of more than 48 hours increases hospital stay of patients with acute cholangitis
Endoscopic retrograde cholangiopancreatography (ERCP) must be performed in patients with acute cholangitis within 2 days of presentation, suggests a recent study, adding that a delay of 48 or more hours may disproportionately increase hospital stay.
Furthermore, a delay of >72 hours is associated with additional adverse outcomes including hypotension requiring vasopressor support.
To define the optimal timing of ERCP for patients with acute cholangitis, researchers prospectively collected clinical data on all cases of cholangitis managed by ERCP from September 2010 to July 2013. They then determined the clinical impact of the time to ERCP, defined as the time from presentation in the emergency department to the commencement of the procedure.
Length of hospitalization was the primary outcome assessed. Secondary outcomes included vasopressor use, endotracheal intubation, intensive care unit (ICU) admission and death.
Of the 199 patients with cholangitis, 182 (92 percent) had a successful ERCP. Patients undergoing ERCP at ≥48 vs <48 hours (median, 9.1 vs 6.5 days; p=0.004) had significantly longer length of hospitalization even though these patients having ERCP at ≥48 hours were less sick as shown by less frequent ICU admission (odds ratio [OR], 0.3; 95 percent CI, 0.2 to 0.6).
Hospitalization increased by 1.44 days for every day ERCP was delayed (p<0.001), according to multivariate analysis. ERCP ≥72 compared with <72 hours indicated ORs of 2.6 (1.0 to 7.0) for vasopressor requirement and 3.6 (0.8 to 15.9) for mortality. Time to ERCP was not associated with procedural adverse events or technical success.
“Acute cholangitis mandates resuscitation, antibiotic therapy and biliary decompression,” researchers said.