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. 2017 Jul 16;5(7):280-285.
doi: 10.12998/wjcc.v5.i7.280.

Feasibility of initial endoscopic common bile duct stone removal in patients with acute cholangitis

Akira Yamamiya  1 , Katsuya Kitamura  1 , Yu Ishii  1 , Yuta Mitsui  1 , Tomohiro Nomoto  1 , Hitoshi Yoshida  1
Affiliations

Feasibility of initial endoscopic common bile duct stone removal in patients with acute cholangitis

Akira Yamamiya et al. World J Clin Cases. .

Abstract

Aim: To investigate the feasibility of initial endoscopic common bile duct (CBD) stone removal in patients with acute cholangitis (AC).

Methods: A single-center, retrospective study was conducted between April 2013 and December 2014 and was approved by the Medical Ethics Committee at our institution. Written informed consent was obtained from each patient prior to the procedure. The cohort comprised 31 AC patients with CBD stones who underwent endoscopic biliary drainage (EBD) for naïve papilla within 48 h after AC onset. We retrospectively divided the participants into two groups: 19 patients with initial endoscopic CBD stone removal (initial group) and 12 patients with delayed endoscopic CBD stone removal (delayed group). We evaluated the feasibility of initial endoscopic CBD stone removal in patients with AC.

Results: We observed no significant differences between the groups regarding patient characteristics. According to the assessments based on the Tokyo Guidelines, the AC severity of patients with initial endoscopic CBD stone removal was mild to moderate. The use of antithrombotic agents before EBD was less frequent in the initial group than in the delayed group (11% vs 58%, respectively; P = 0.004). All the patients underwent successful endoscopic CBD stone removal and adverse events did not differ significantly between the groups. The number of endoscopic retrograde cholangiopancreatography procedures was significantly lower in the initial group than in the delayed group [median (interquartile range) 1 (1-1) vs 2 (2-2), respectively; P < 0.001]. The length of hospital stay was significantly shorter for the initial group than for the delayed group [10 (9-15) vs 17 (14-20), respectively; P = 0.010].

Conclusion: Initial endoscopic CBD stone removal in patients with AC may be feasible when AC severity and the use of antithrombotic agents are carefully considered.

Keywords: Acute cholangitis; Common bile duct stone; Endoscopic retrograde cholangiopancreatography; Feasibility; Initial endoscopic common bile stone removal.

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Conflict of interest statement

Conflict-of-interest statement: We have no financial relationships to disclose.

Figures

Figure 1
Figure 1
Flow diagram of patient selection process. ERCP: Endoscopic retrograde cholangiopancreatography; EBD: Endoscopic biliary drainage; AC: Acute cholangitis; CBD: Common bile duct.
See this image and copyright information in PMC

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References

    1. Takada T, Strasberg SM, Solomkin JS, Pitt HA, Gomi H, Yoshida M, Mayumi T, Miura F, Gouma DJ, Garden OJ, et al. TG13: Updated Tokyo Guidelines for the management of acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci. 2013;20:1–7. - PubMed
    1. Takada T, Kawarada Y, Nimura Y, Yoshida M, Mayumi T, Sekimoto M, Miura F, Wada K, Hirota M, Yamashita Y, et al. Background: Tokyo Guidelines for the management of acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Surg. 2007;14:1–10. - PMC - PubMed
    1. Fujimoto K, Fujishiro M, Kato M, Higuchi K, Iwakiri R, Sakamoto C, Uchiyama S, Kashiwagi A, Ogawa H, Murakami K, et al. Guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment. Dig Endosc. 2014;26:1–14. - PubMed
    1. Cotton PB, Lehman G, Vennes J, Geenen JE, Russell RC, Meyers WC, Liguory C, Nickl N. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc. 1991;37:383–393. - PubMed
    1. Lipsett PA, Pitt HA. Acute cholangitis. Surg Clin North Am. 1990;70:1297–1312. - PubMed