Comparison between emergency and elective endoscopic sphincterotomy in patients with acute cholangitis due to choledocholithiasis: is emergency endoscopic sphincterotomy safe?
OBJECTIVE
We retrospectively assessed post-EST complications and examined whether combination therapy comprising endoscopic biliary drainage (EBD) plus endoscopic sphincterotomy (EST) as the initial treatment is safe in patients with acute cholangitis due to choledocholithiasis.


METHODS
Among the 363 consecutive patients with acute cholangitis due to choledocholithiasis who were treated in our hospital between December 1992 and December 2006, the subjects comprised 127 patients with moderate acute cholangitis for whom EBD and EST were carried out. Factors influencing risk factors for post-EST pancreatitis, hemorrhage and hospitalization were determined by multivariate analysis.


RESULTS
Multivariate analysis revealed that only precut sphincterotomy (PST) was a significant risk factor for post-EST pancreatitis, and the incidence of pancreatitis in patients who underwent PST was significantly higher than that in those who did not (P = 0.041). Only age was a significant risk factor for post-EST hemorrhage, and younger patients were likely to experience hemorrhage after EST (P = 0.021). Total bilirubin and the timing of EST were significant factors associated with hospitalization. Hospitalization in patients who underwent EBD plus EST as the initial treatment (emergency EST) was significantly shorter than that in those who palliatively underwent EST after EBD (elective EST; 11.8 vs. 16.2 days, P = 0.001).


CONCLUSIONS
Combination therapy comprising EBD plus EST as the initial treatment for patients with moderate acute cholangitis due to choledocholithiasis was safe and did not prolong the period of hospitalization.
Ueki
Toshiharu
T
Department of Gastroenterology, Chikushi Hospital, Fukuoka University, 1-1-1 Zokumyoin, Chikushino, Fukuoka 818-8502, Japan. tueki@cis.fukuoka-u.ac.jp
Otani
Keisuke
K
Fujimura
Naruhito
N
Shimizu
Aiko
A
Otsuka
Yuichiro
Y
Kawamoto
Kenichiro
K
Matsui
Toshiyuki
T
D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002761:Cholangitis / Q000209:etiology* / Q000628:therapy*; D042883:Choledocholithiasis / Q000150:complications*; D003131:Combined Modality Therapy; D004322:Drainage / Q000009:adverse effects; D017558:Elective Surgical Procedures; D004630:Emergencies; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology / Q000209:etiology; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D015999:Multivariate Analysis; D010195:Pancreatitis / Q000453:epidemiology / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects; D016896:Treatment Outcome