Predicting factors of delayed versus early definitive ERCP for stone clearance in patients with common bile duct stone and acute cholangitis managed with temporary biliary stenting
Refereed conference paper presented and published in conference proceedings


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AbstractBackground: While ERCP with endoscopic sphincterotomy (ES) and stone extraction can be safely performed as definitive treatment in the majority of patients with common bile duct (CBD) stone on initial presentation, temporary stent placement for biliary drainage is often preferred in patients with severe acute cholangitis and sepsis. The optimal timing of subsequent definitive ERCP for stone clearance in this subgroup of patients is not well defined. This study aims to identify predicting factors of the timing of definitive ERCP for stone clearance in patients managed with temporary biliary stenting for acute cholangitis and CBD stone. Methods: Retrospective review of an ERCP database in a university hospital from January 2013 to December 2014 was performed. Patients who underwent ERCP with temporary biliary stenting for acute cholangitis and CBD stone were identified. Early definitive ERCP was defined as a follow up ERCP done < 7 days after the index ERCP, while delayed definitive ERCP was defined as a follow up ERCP done > 7 days after the index ERCP. Patients' demographics, clinical parameters at the time of the ERCP, and ERCP findings were collected. Logistic regression was used to identify predicting factors of the timing of definitive ERCP. Results: A total of 1611 ERCPs were performed in the study period, of which 613 ERCPs were done for bile duct stones. 91 patients with CBD stone and acute cholangitis underwent temporary biliary stenting for initial management. 8 patients were excluded because they had partial stone clearance before stenting or no subsequent definitive ERCP. 83 patients were included in the analysis: 34 patients had early definitive ERCP (mean age 73; 64.7% male) and 49 patients (mean age 75; 51.0% male) had delayed definitive ERCP for stone clearance. The mean time intervals between the index ERCP and the definitive ERCP were 4.4 days (range 2-7) in the early group and 44.6 days (range 8-162) in the delayed group (Table 1). The proportion of patients with CBD stone > 10mm was significantly higher in the delayed definitive ERCP group (41.2% in early group vs 65.3% in delayed group, p=0.030). While age, presence of hypotension, need for pressor support, intensive care unit admission, and CBD stone > 10mm on index ERCP were found to have odds ratios (OR) > 1 on univariate logistic regression analysis for delayed definitive ERCP for stone clearance, only CBD stone > 10mm was shown to be a statistically significant predictor on both univariate and multivariate logistic regression (univariate: OR 2.69, p = 0.031, multivariate: OR 2.50, p = 0.050) (Table 2). Conclusion: In patients with CBD stone and acute cholangitis managed with temporary biliary stenting, the finding of CBD stone > 10mm on index ERCP was a significant predictor for delayed definitive ERCP for stone clearance. (Table presented).
All Author(s) ListTang RS, Lam SF, Chan PY, Tang MC, Leung WH, He Y, Lam TY, Ng SC, Chan FK, Lau JY
Name of ConferenceDigestive Disease Week
Start Date of Conference21/05/2016
End Date of Conference24/05/2016
Place of ConferenceSan Diego
Country/Region of ConferenceUnited States of America
Journal nameGastrointestinal Endoscopy
Proceedings TitleGastrointestinal Endoscopy
Detailed descriptionBackground: While ERCP with endoscopic sphincterotomy (ES) and stone extraction can be safely performed as definitive treatment in the majority of patients with common bile duct (CBD) stone on initial presentation, temporary stent placement for biliary drainage is often preferred in patients with severe acute cholangitis and sepsis. The optimal timing of subsequent definitive ERCP for stone clearance in this subgroup of patients is not well defined. This study aims to identify predicting factors of the timing of definitive ERCP for stone clearance in patients managed with temporary biliary stenting for acute cholangitis and CBD stone. Methods: Retrospective review of an ERCP database in a university hospital from January 2013 to December 2014 was performed. Patients who underwent ERCP with temporary biliary stenting for acute cholangitis and CBD stone were identified. Early definitive ERCP was defined as a follow up ERCP done < 7 days after the index ERCP, while delayed definitive ERCP was defined as a follow up ERCP done > 7 days after the index ERCP. Patients' demographics, clinical parameters at the time of the ERCP, and ERCP findings were collected. Logistic regression was used to identify predicting factors of the timing of definitive ERCP. Results: A total of 1611 ERCPs were performed in the study period, of which 613 ERCPs were done for bile duct stones. 91 patients with CBD stone and acute cholangitis underwent temporary biliary stenting for initial management. 8 patients were excluded because they had partial stone clearance before stenting or no subsequent definitive ERCP. 83 patients were included in the analysis: 34 patients had early definitive ERCP (mean age 73; 64.7% male) and 49 patients (mean age 75; 51.0% male) had delayed definitive ERCP for stone clearance. The mean time intervals between the index ERCP and the definitive ERCP were 4.4 days (range 2-7) in the early group and 44.6 days (range 8-162) in the delayed group (Table 1). The proportion of patients with CBD stone > 10mm was significantly higher in the delayed definitive ERCP group (41.2% in early group vs 65.3% in delayed group, p=0.030). While age, presence of hypotension, need for pressor support, intensive care unit admission, and CBD stone > 10mm on index ERCP were found to have odds ratios (OR) > 1 on univariate logistic regression analysis for delayed definitive ERCP for stone clearance, only CBD stone > 10mm was shown to be a statistically significant predictor on both univariate and multivariate logistic regression (univariate: OR 2.69, p = 0.031, multivariate: OR 2.50, p = 0.050) (Table 2). Conclusion: In patients with CBD stone and acute cholangitis managed with temporary biliary stenting, the finding of CBD stone > 10mm on index ERCP was a significant predictor for delayed definitive ERCP for stone clearance. (Table presented).
Year2016
Month5
Volume Number83
Issue Number5 Suppl.
PagesAB622
ISSN0016-5107
LanguagesEnglish-United States

Last updated on 2021-14-05 at 02:25