title: Management for CBD stone-related mild to moderate acute cholangitis: urgent versus elective ERCP.
abstract: BACKGROUND
  There is no doubt that urgent biliary decompression needs to be done in case of severe acute cholangitis. However, it remains to be determined how early biliary decompression should be performed and elective intervention would be comparable to urgent intervention, in case of mild to moderate choledocholithiasis associated cholangitis.
  
  
  METHODS
  One hundred ninety-five patients were enrolled who were diagnosed with mild to moderate cholangitis with common bile duct (CBD) stones between January 2006 and August 2010. They were divided into two groups according to door to intervention time, and urgent (≤24 h, n = 130) versus elective (>24 h, n = 82). Primary outcomes of this study were technical success rate (CBD stones removal) and clinical success rate (improvement of cholangitis) between the two groups. Hospital stay and intervention-related complications were also evaluated.
  
  
  RESULTS
  There was no statistically significant difference in technical, clinical success rate and intervention-related complications between the urgent and elective groups (P = 0.737, 0.285, 0.398, respectively). Patients in the urgent group had significantly shorter hospitalization than in the elective group (6.8 vs. 9.2 days, P < 0.001), and furthermore, intervention to discharge time was also significantly shorter by 1.1 days in the urgent group (P = 0.035). In terms of laboratory parameters, initial CRP level was the only factor correlated with hospital stay and intervention to discharge time.
  
  
  CONCLUSIONS
  This study demonstrates that urgent ERCP would be recommended in the management of patients with CBD stone-related mild to moderate acute cholangitis because of the advantage of short hospital stay and intervention to discharge time.
authors: Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seoungnam-si, Gyeonggi-do 463-707, South Korea.
authors: Sang Eon
authors: SE
authors: Jang
authors: Sang Wook
authors: SW
authors: Park
authors: Ban Seok
authors: BS
authors: Lee
authors: Cheol Min
authors: CM
authors: Shin
authors: Sang Hyub
authors: SH
authors: Lee
authors: Jin-Wook
authors: JW
authors: Kim
authors: Sook-Hyang
authors: SH
authors: Jeong
authors: Nayoung
authors: N
authors: Kim
authors: Dong Ho
authors: DH
authors: Lee
authors: Joo Kyung
authors: JK
authors: Park
authors: Jin-Hyeok
authors: JH
authors: Hwang
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002761:Cholangitis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D042883:Choledocholithiasis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods*; D017558:Elective Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome