Zhou Y, Zhang YQ, Huang SJ, Liang Y, Liang X, Wali M, Feng YD. Urgent one-stage endoscopic treatment for choledocholithiasis related moderate to severe acute cholangitis: A propensity score-matched analysis. World J Gastroenterol 2024; 30(15): 2118-2127 [PMID: 38681983 DOI: 10.3748/wjg.v30.i15.2118]
Corresponding Author of This Article
Ya-Dong Feng, MD, PhD, Chief Doctor, Department of Gastroenterology, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Dingjiaqiao Road, Nanjing 210009, Jiangsu Province, China. drfengyd@126.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Control Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Apr 21, 2024; 30(15): 2118-2127 Published online Apr 21, 2024. doi: 10.3748/wjg.v30.i15.2118
Table 1 Characteristics of the study population and endoscopic retrograde cholangiopancreatography procedures
Before matching
After matching
Total, n = 254
ERCP ≤ 24 h, n = 102
ERCP > 24 h, n = 152
P value
Total, n = 186
ERCP ≤ 24 h, n = 93
ERCP > 24 h, n = 93
P value
Age, yr
69.47 ± 15.81
70.73 ± 15.24
68.63 ± 16.18
0.362
70.32 ± 15.39
71.05 ± 15.26
69.58 ± 15.56
0.515
Male sex, n (%)
121 (47.6)
58 (56.9)
63 (41.4)
0.016
94 (50.5)
54 (58.1)
40 (43)
0.04
CCI
1 (0-7)
1 (0-5)
1 (0-7)
0.108
1 (0-7)
1 (0-3)
1 (0-7)
0.187
Past medical history
ERCP, n (%)
30 (11.8)
13 (12.7)
17 (11.2)
0.706
22 (11.8)
13 (14)
9 (9.7)
0.364
Cholecystectomy, n (%)
67 (26.4)
27 (26.5)
40 (26.3)
0.978
44 (23.7)
22 (23.7)
22 (23.7)
1
Lab values
WBC count as/μL
10.32 ± 6.71
12.57 ± 6.61
8.81 ± 6.37
< 0.001
10.58 ± 7.03
12.11 ± 6.44
9.06 ± 7.3
0.003
Platelet count as/μL
173.96 ± 71.08
164.21 ± 73.35
180.5 ± 68.99
0.594
168.11 ± 71.33
164.85 ± 74.65
171.38 ± 68.09
0.534
CRP in mg/L
75.17 ± 76.03
94.9 ± 79.32
61.75 ± 70.95
< 0.001
78.53 ± 76.6
89.66 ± 76.37
76.37 ± 75.75
0.079
NLR (%)
7.94 (0.81-106.31)
15.67 (1.36-106.31)
6.9 (0.805-64.13)
< 0.001
18.545 (2.55-64.13)
19.87 (11.2)
16.42 (2.55-64.13)
< 0.001
INR
1.2 ± 0.22
1.23 ± 0.97
1.14 ± 0.92
< 0.001
1.21 ± 0.23
1.25 ± 0.27
1.17 ± 0.17
0.012
D2 polymers
657 (0.21-26652)
1567 (76-26652)
504 (0.38-15502)
< 0.001
1193.5 (479-15502)
1455 (479-4811)
832 (504-15502)
0.005
Creatinine in mg/dL
0.826 (0.34-8.32)
1.01 (0.34-5.86)
0.76 (0.44-8.32)
< 0.001
1.10 (0.77-5.86)
1.15 (0.77-5.86)
1.02 (0.79-3.1)
0.013
TB in mg/dL
2.61 (0.28-22.52)
3.7 (0.29-15.02)
2.14 (0.28-22.52)
0.021
3.58 ± 2.98
3.78 ± 2.8
3.38 ± 3.14
0.363
AST in U/L
108.5 (13-4051)
128.5 (13-744)
104 (15-4051)
0.168
118 (40-539)
131 (40-497)
116 (46-539)
0.53
ALT in U/L
201.68 ± 206.61
196.67 ± 173.10
205.03 ± 226.84
0.652
222 (68-512)
259 (68-512)
209 (88-479)
0.55
γ-GT in U/L
406.66 ± 354.98
425.8 ± 376.89
393.82 ± 340.16
0.463
383.61 ± 332.61
405.97 ± 347.74
361.25 ± 361.25
0.361
Albumin in g/dL
35.8 (15.9-46.6)
35.9 (15.9-48.7)
37.8 (25.1-49.1)
0.033
33.7 (24.3-36.1)
32.6 (24.3-35.7)
33.8 (25.4-36.1)
0.163
Tokyo Score
3
48 (28)
39 (38.2)
32 (21.1)
0.003
58 (31.2)
35 (37.6)
23 (24.7)
0.058
2
206 (72)
63 (61.8)
120 (78.9)
128 (68.8)
58 (62.4)
70 (75.3)
ERCP procedure
Door to ERCP time in h
48 (1-312)
8.5 (1-24)
120 (27-312)
< 0.001
25.5 (1-312)
9 (1-24)
120 (27-312)
< 0.001
ERCP procedure time (min)
60 (25-780)
60 (30-200)
60 (30-335)
0.714
60 (26-780)
60 (30-200)
60 (30-335)
0.52
One-stage ERCP, n (%)
254 (100)
102 (100)
152 (100)
1
186 (100)
93 (100)
93 (100)
1
CBD, n (%)
254 (100)
102 (100)
152 (100)
1
186 (100)
93 (100)
93 (100)
1
Stones size (mm)
8 (2-25)
9 (2-25)
8 (2-25)
0.222
8 (2-25)
9 (2-25)
8 (2-25)
0.368
Multiple stones, n (%)
109 (42.9)
35 (34.3)
74 (48.7)
0.023
79 (42.5)
32 (34.4)
47 (50.5)
0.026
Common bile duct width (mm)
13 (4-33)
14 (4-33)
14 (5-33)
0.016
13 (4-33)
13 (4-33)
12.1 (5-25)
0.038
EST, n (%)
177 (69.7)
75 (73.5)
102 (67.1)
0.275
128 (68.8)
69 (74.2)
59 (63.4)
0.113
EPBD, n (%)
204 (80.3)
90 (88.2)
114 (75)
0.009
149 (80.1)
83 (89.2)
66 (71)
0.002
Pancreatic stent placement, n (%)
21 (8.3)
5 (4.9)
16 (10.5)
0.111
15 (8.1)
5 (5.4)
10 (10.8)
0.178
Nasal Biliary Drainage Catheter placement, n (%)
251 (98.8)
100 (98)
151 (99.3)
0.346
183 (98.4)
91 (97.8)
92 (98.9)
0.561
HLL, n (%)
21 (8.3)
11 (10.8)
10 (6.6)
0.233
16 (8.6)
11 (11.8)
5 (5.4)
0.117
Table 2 Outcomes of endoscopic retrograde cholangiopancreatography
Before matching
After matching
Total, n = 254
ERCP ≤ 24 h, n = 102
ERCP > 24 h, n = 152
P value
Total, n = 186
ERCP ≤ 24 h, n = 93
ERCP > 24 h, n = 93
P value
ERCP intervention type, n (%)
Complete stone removal
250 (98.4)
101 (99)
149 (98)
0.533
184 (98.9)
92 (98.9)
92 (98.9)
1
Biliary stent insertion
4 (1.6)
1 (1)
3 (2)
0.533
2 (1.1)
1 (1.1)
1 (1.1)
1
Technical success rate, n (%)
250 (98.4)
101(99)
149 (98)
0.533
183 (98.4)
92 (98.9)
91 (98)
0.561
ERCP failure, n (%)
4 (1.6)
1 (1)
3 (2)
0.533
3 (1.6)
1 (1.1)
2 (2.2)
1
Duration of antibiotic use (d)
7 (1-28)
6 (2-15)
8 (2-26)
< 0.001
7 (2-28)
6 (2-18)
9 (2-28)
< 0.001
In-hospital mortality, n (%)
3 (1.2)
0
3 (2)
0.153
2 (1.1)
0
2 (2.2)
0.155
30-d mortality, n (%)
7 (2.8)
2 (2)
5 (3.3)
0.526
5 (2.7)
2 (2.2)
3 (3.2)
0.65
Recurrent cholangitis, n (%)
7 (2.8)
3 (2.9)
4 (2.6)
0.883
6 (3.2)
3 (3.2)
3 (3.2)
1
LOHS, (d)
10 (3-71)
9 (3-39)
18 (5-71)
< 0.001
9 (3-71)
9 (3-39)
18.5 (7-71)
< 0.001
Required ICU stay, n (%)
61 (24)
33 (32.4)
28 (18.4)
0.011
52 (28)
32 (34.4)
20 (21.5)
0.05
ICU stay length, (d)
9 (1-71)
3 (1-15)
8 (1-71)
0.003
4.5 (1-71)
3 (1-15)
9 (1-71)
< 0.001
30 d readmission, n (%)
33 (13)
15 (14.7)
18 (11.8)
0.506
29 (15.6)
14 (15.1)
15 (16.1)
0.84
ERCP-related complications, n (%)
42 (16.5)
18 (17.7)
24 (15.8)
0.696
29 (15.6)
16 (17.2)
13 (14)
0.544
PEP
23 (9.1)
9 (8.8)
14 (9.2)
0.916
17 (9.1)
9 (9.7)
8 (8.6)
0.799
Cholangitis
9 (3.5)
6 (5.9)
3 (2)
0.099
7 (3.8)
5 (5.4)
2 (2.2)
0.248
Bleeding
6 (2.4)
4 (3.9)
2 (1.3)
0.18
4 (2.2)
3 (3.2)
1 (1.1)
0.312
Others
2 (0.8)
2 (2)
0
0.083
2 (1.1)
2 (2.2)
0
0.155
Table 3 Linear regression analyses to assess intensive care unit length of stay
Univariate analysis
Multivariate analysis
OR (95%CI)
P value
OR (95%CI)
P value
WBC count
0.503 (0.185 to 0.821)
0.003
-0.092 (-0.305 to 0.12)
0.387
Platelet count
-0.031 (-0.069 to 0.007)
0.105
CRP
0.046 (0.009 to 0.082)
0.015
0.002 (0.021 to 0.024)
0.877
NLR
-0.006 (-0.181 to 0.169)
0.945
INR
-4.986 (-15.932 to 5.961)
0.365
TB
-0.101 (-1.26 to 1.058)
0.862
Cr
6.248 (4.216 to 8.281)
< 0.001
1.818 (0.073 to 3.564)
0.042
Albumin
0.569 (0.043 to 1.095)
0.035
0.02 (-0.308 to 0.347)
0.905
ALT
-0.005 (-0.017 to 0.007)
0.375
AST
-0.001 (-0.007 to 0.005)
0.789
Multiple stones
-3.31 (-9.87 to 3.249)
0.316
CCI
1.466 (-0.713 to 3.644)
0.183
Age
-0.367 (-0.663 to -0.072)
0.016
-0.086 (-0.256 to 0.083)
0.312
Severity of AC
3.188 (-3.434 to 9.809)
0.338
Time to ERCP
0.051 (0.340 to 0.059)
< 0.001
0.044 (0.033 to 0.056)
< 0.001
Common bile duct width
-0.002 (-0.34 to 0.335)
0.988
Table 4 Outcomes of endoscopic retrograde cholangiopancreatography in the propensity matched population (Tokyo score 3 subgroup)
Patients with Grade III AC
Total, n = 58
ERCP ≤ 24 h, n = 35
ERCP > 24 h, n = 23
P value
Duration of antibiotic use (d)
8 (3-28)
7 (3-15)
11 (3-28)
0.004
In-hospital mortality, n (%)
1 (1.7)
0
1 (4.3)
0.213
30-d mortality, n (%)
4 (6.9)
2 (5.7)
2 (8.7)
0.661
Recurrent cholangitis, n (%)
4 (6.9)
2 (5.7)
2 (8.7)
0.661
LOHS, (d)
13 (6-71)
9 (6-17)
20 (14-71)
< 0.001
Required ICU stay, n (%)
32 (55.2)
21 (60)
11 (47.8)
0.362
ICU stay length, (d)
6 (1-71)
4 (1-15)
11 (1-71)
0.014
30 d readmission, n (%)
10 (17.2)
6 (17.1)
4 (17.4)
0.98
ERCP-related complications, n (%)
11 (19)
8 (22.9)
3 (13)
0.351
PEP
4 (6.9)
3 (8.6)
1 (4.3)
0.535
Cholangitis
3 (5.2)
3 (8.6)
0
0.149
Bleeding
2 (3.4)
1 (2.9)
1 (4.3)
0.761
Others
1 (1.7)
1 (2.9)
0
0.414
Citation: Zhou Y, Zhang YQ, Huang SJ, Liang Y, Liang X, Wali M, Feng YD. Urgent one-stage endoscopic treatment for choledocholithiasis related moderate to severe acute cholangitis: A propensity score-matched analysis. World J Gastroenterol 2024; 30(15): 2118-2127