Does the addition of endoscopic sphincterotomy to stent insertion improve drainage of the bile duct in acute suppurative cholangitis?
BACKGROUND
The treatment of patients with bile duct stones and acute suppurative cholangitis is emergent biliary decompression either by endoscopic sphincterotomy, nasobiliary drainage, or stent insertion. The aim of this retrospective study was to determine whether endoscopic sphincterotomy, in addition to an internal endoprosthesis, improves outcome for patients with acute suppurative cholangitis.


METHODS
A total of 74 patients with acute suppurative cholangitis and bile duct stones were included in the study; 37 had endoscopic sphincterotomy before insertion of plastic stent (Group 1), and 37 had a plastic stent inserted through an intact papilla (Group 2).


RESULTS
The success rates for stent insertion in Groups 1 and 2 were, respectively, 89.2% and 86.5% (p = 1.000). The complication rates in Group 1 and Group 2 were, respectively, 10.8% and 2.7% (p = 0.358). The median (interquartile range 25th-75th percentile) durations of hospital stay for patients in Group 1 and Group 2 were, respectively, 6.5 (4-11) days and 7 (5-12) days (p = 0.614). The median (interquartile range) lengths of time for resolution of jaundice in Group 1 and Group 2 were, respectively, 3 (2-6) days versus 4 (2-5) days (p = 0.981).


CONCLUSIONS
Endoscopic sphincterotomy, in addition to biliary stent insertion, is not required for successful biliary decompression in patients with severe acute cholangitis.
Hui
Chee-Kin
CK
Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
Lai
Kam-Chuen
KC
Yuen
Man-Fung
MF
Ng
Matthew
M
Chan
Chi-Kuen
CK
Hu
Wayne
W
Wong
Wai-Man
WM
Lai
Ching-Lung
CL
Wong
Benjamin C Y
BC
D000208:Acute Disease; D002761:Cholangitis / Q000601:surgery* / Q000628:therapy; D019299:Decompression, Surgical; D004322:Drainage; D006801:Humans; D012189:Retrospective Studies; D016717:Sphincterotomy, Endoscopic; D015607:Stents; D016896:Treatment Outcome