Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 16, 2017; 5(7): 280-285
Published online Jul 16, 2017. doi: 10.12998/wjcc.v5.i7.280
Feasibility of initial endoscopic common bile duct stone removal in patients with acute cholangitis
Akira Yamamiya, Katsuya Kitamura, Yu Ishii, Yuta Mitsui, Tomohiro Nomoto, Hitoshi Yoshida
Akira Yamamiya, Katsuya Kitamura, Yu Ishii, Yuta Mitsui, Tomohiro Nomoto, Hitoshi Yoshida, Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, Tokyo 142-8666, Japan
Author contributions: Kitamura K designed this study as well as collected and analyzed the data; Yamamiya A analyzed the data and drafted the manuscript; Kitamura K checked the manuscript and approved the final version; Yamamiya A, Kitamura K, Ishii Y, Mitsui Y, Nomoto T and Yoshida H participated in this study as either endoscopic operators or assistants.
Institutional review board statement: This study was approved by the Medical Ethics Committee at Showa University.
Informed consent statement: Written informed consent was obtained from each patient prior to the procedure.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: 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/
Correspondence to: Katsuya Kitamura, MD, PhD, Lecturer, Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan. k.kitamura@med.showa-u.ac.jp
Telephone: +81-3-37848535 Fax: +81-3-37847553
Received: March 15, 2017
Peer-review started: March 16, 2017
First decision: May 22, 2017
Revised: May 26, 2017
Accepted: June 19, 2017
Article in press: June 20, 2017
Published online: July 16, 2017
Abstract
AIM

To investigate the feasibility of initial endoscopic common bile duct (CBD) stone removal in patients with acute cholangitis (AC).

METHODS

A single-center, retrospective study was conducted between April 2013 and December 2014 and was approved by the Medical Ethics Committee at our institution. Written informed consent was obtained from each patient prior to the procedure. The cohort comprised 31 AC patients with CBD stones who underwent endoscopic biliary drainage (EBD) for naïve papilla within 48 h after AC onset. We retrospectively divided the participants into two groups: 19 patients with initial endoscopic CBD stone removal (initial group) and 12 patients with delayed endoscopic CBD stone removal (delayed group). We evaluated the feasibility of initial endoscopic CBD stone removal in patients with AC.

RESULTS

We observed no significant differences between the groups regarding patient characteristics. According to the assessments based on the Tokyo Guidelines, the AC severity of patients with initial endoscopic CBD stone removal was mild to moderate. The use of antithrombotic agents before EBD was less frequent in the initial group than in the delayed group (11% vs 58%, respectively; P = 0.004). All the patients underwent successful endoscopic CBD stone removal and adverse events did not differ significantly between the groups. The number of endoscopic retrograde cholangiopancreatography procedures was significantly lower in the initial group than in the delayed group [median (interquartile range) 1 (1-1) vs 2 (2-2), respectively; P < 0.001]. The length of hospital stay was significantly shorter for the initial group than for the delayed group [10 (9-15) vs 17 (14-20), respectively; P = 0.010].

CONCLUSION

Initial endoscopic CBD stone removal in patients with AC may be feasible when AC severity and the use of antithrombotic agents are carefully considered.

Keywords: Acute cholangitis, Common bile duct stone, Feasibility, Initial endoscopic common bile stone removal, Endoscopic retrograde cholangiopancreatography

Core tip: Initial endoscopic common bile duct stone removal in patients with acute cholangitis (AC) may be feasible when AC severity and the use of antithrombotic agents are carefully considered.