Tsou YK, Su YT, Lin CH, Liu NJ. Acute cholangitis: Does malignant biliary obstruction vs choledocholithiasis etiology change the clinical presentation and outcomes? World J Clin Cases 2023; 11(29): 6984-6994 [PMID: 37946763 DOI: 10.12998/wjcc.v11.i29.6984]
Corresponding Author of This Article
Nai-Jen Liu, MD, Assistant Professor, Doctor, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, No. 5 Fu-Shin Street, Kweishan, Taoyuan 333, Taiwan. milk1372@cloud.cgmh.org.tw
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort 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 Clin Cases. Oct 16, 2023; 11(29): 6984-6994 Published online Oct 16, 2023. doi: 10.12998/wjcc.v11.i29.6984
Acute cholangitis: Does malignant biliary obstruction vs choledocholithiasis etiology change the clinical presentation and outcomes?
Yung-Kuan Tsou, Yi-Tse Su, Cheng-Hui Lin, Nai-Jen Liu
Yung-Kuan Tsou, Yi-Tse Su, Cheng-Hui Lin, Nai-Jen Liu, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
Author contributions: Tsou YK contributed to the conceptualization of the study and original manuscript writing; Su YT contributed to data collection, planning, interpretation and formal analysis; Lin CH contributed to manuscript review and editing; Liu NJ worked on the conceptualization of the study and revised the final version of the submitted manuscript.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Chang Gung Memorial Hospital (IRB No. 202201601B0).
Informed consent statement: Since this was a retrospective study using routine clinical treatment or diagnostic medical records, the Chang Gung Medical Foundation Institutional Review Board approved the waiver of the participant's consent.
Conflict-of-interest statement: The authors declare no conflict of interest.
Data sharing statement: Deidentified individual participant data are available and will be provided on reasonable request to the corresponding author.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nai-Jen Liu, MD, Assistant Professor, Doctor, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, No. 5 Fu-Shin Street, Kweishan, Taoyuan 333, Taiwan. milk1372@cloud.cgmh.org.tw
Received: August 13, 2023 Peer-review started: August 13, 2023 First decision: August 24, 2023 Revised: September 2, 2023 Accepted: September 26, 2023 Article in press: September 26, 2023 Published online: October 16, 2023
ARTICLE HIGHLIGHTS
Research background
Whether the clinical outcome of acute cholangitis (AC) differs depending on the cause is unknown.
Research motivation
This study aimed to elucidate whether the clinical manifestations and outcomes of AC caused by malignant biliary obstruction (MBO) and choledocholithiasis differ.
Research objectives
The primary outcome comparison was 30-d mortality. The secondary outcome comparisons were intensive care unit admission rate, length of hospital stay, and 30-d readmission rate.
Research methods
This retrospective study included 516 patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) due to AC caused by MBO (MBO group, n = 56) and common bile duct stones (CBDS group, n = 460). Clinical and laboratory parameters were compared between the groups. Propensity score matching (PSM) created 55 matched pairs. Confounders used in the PSM analysis were age, sex, time to ERCP, and technical success of ERCP. The primary outcome comparison was 30-d mortality. The secondary outcome comparisons were intensive care unit admission rate, length of hospital stay, and 30-d readmission rate.
Research results
The 30-d mortality, intensive care unit admission rates, 30-d readmission rates, and length of hospital stay were significantly higher or longer in the MBO group. However, only the length of hospital stay remained significant in the propensity score matching analysis. Multivariate analysis revealed that time-to-ERCP and multiple organ dysfunction were independent factors associated with 30-d mortality.
Research conclusions
MBO patients undergo ERCP later, and the prognosis is worse than that of patients with choledocholithiasis. Therefore, newly diagnosed MBO patients with clinically suspected AC should be alerted and ERCP should be performed as soon as possible for biliary drainage.
Research perspectives
The diagnostic criteria used for systemic inflammation may differ between patients with MBO and those with choledocholithiasis, and this may be considered in the development of new guidelines in the future.
