scholarly journals Optimal timing of endoscopic retrograde cholangiopancreatography for acute cholangitis associated with distal malignant biliary obstruction

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Namyoung Park ◽  
Sang Hyub Lee ◽  
Min Su You ◽  
Joo Seong Kim ◽  
Gunn Huh ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Biliary Obstruction ◽  
Acute Cholangitis ◽  
Mortality Rates ◽  
Malignant Biliary Obstruction ◽  
Optimal Timing ◽  
Endoscopic Retrograde ◽  
The Difference ◽  
Distal Malignant Biliary Obstruction

Abstract Background There is a lack of studies regarding the optimal timing for endoscopic retrograde cholangiopancreatography (ERCP) in patients with cholangitis caused by distal malignant biliary obstruction (MBO). This study aims to investigate the optimal timing of ERCP in patients with acute cholangitis associated with distal MBO with a naïve papilla. Methods A total of 421 patients with acute cholangitis, associated with distal MBO, were enrolled for this study. An urgent ERCP was defined as being an ERCP performed within 24 h following emergency room (ER) arrival, and early ERCP was defined as an ERCP performed between 24 and 48 h following ER arrival. We evaluated both 30-day and 180-day mortality as primary outcomes, according to the timing of the ERCP. Results The urgent ERCP group showed the lowest 30-day mortality rate (2.2%), as compared to the early and delayed ERCP groups (4.3% and 13.5%) (P < 0.001). The 180-day mortality rate was lowest in the urgent ERCP group, followed by early ERCP and delayed ERCP groups (39.4%, 44.8%, 60.8%; P = 0.006). A subgroup analysis showed that in both the primary distal MBO group, as well as in the moderate-to-severe cholangitis group, the urgent ERCP had significantly improved in both 30-day and 180-day mortality rates. However, in the secondary MBO and mild cholangitis groups, the difference in mortality rate between urgent, early, and delayed ERCP groups was not significant. Conclusions In patients with acute cholangitis associated with distal MBO, urgent ERCP might be helpful in improving the prognosis, especially in patients with primary distal MBO or moderate-to-severe cholangitis.

scholarly journals Endoscopic ultrasound versus endoscopic retrograde cholangiopancreatography-guided biliary drainage for primary decompression of malignant biliary obstruction: protocol for a systematic review and meta-analysis of randomised controlled trials

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e028156
Author(s):  
Zheng Jin ◽  
Yaping Wei ◽  
Huapeng Lin ◽  
Haitao Huang ◽  
Wen Lv ◽  
...  
Keyword(s):  
Systematic Review ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Biliary Drainage ◽  
Biliary Obstruction ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Malignant Biliary Obstruction ◽  
Controlled Trials ◽  
Endoscopic Retrograde ◽  
Randomised Controlled

IntroductionCurrent evidence supporting the utility of endoscopic ultrasound-guided biliary drainage (EUS-BD) as a first-line treatment option for malignant biliary obstruction (MBO) is limited. We plan to provide a systematic review and meta-analysis to compare the performance of EUS-BD and endoscopic retrograde cholangiopancreatography-guided biliary drainage (ERCP-BD) as primary palliation of MBO.Methods and analysisRandomised controlled trials evaluating EUS-BD versus ERCP-BD in primary drainage of MBO will be searched in MEDLINE, EMBASE, Web of Science, the Cochrane Library, ClinicalTrials.gov and Google Scholar, from database inception to 31 October 2018. Data on study design, participant characteristics, intervention details and outcomes will be extracted. Primary outcomes to be assessed are technical and clinical success. Secondary outcomes include adverse events, stent patency, stent dysfunction, reinterventions, procedure duration and overall survival. Study quality will be assessed using the Cochrane Risk of Bias Tool. Meta-analysis will be performed using RevMan V.5.3 statistical software. Data will be combined with a random effect model. The results will be presented as a risk ratio for dichotomous data, weighted mean difference for continuous data and HR for time-to-event data. Publication bias will be visualised using funnel plots.Ethics and disseminationThis study will not use primary data, and therefore, formal ethical approval is not required. The findings will be disseminated through peer-reviewed journals and committee conferences.PROSPERO registration numberCRD42018117040

Optimal Timing of Endoscopic Retrograde Cholangiopancreatography in Acute Cholangitis

2017 ◽  
Vol 51 (6) ◽  
pp. 534-538 ◽  
Author(s):  
Linda A. Hou ◽  
Loren Laine ◽  
Nima Motamedi ◽  
Ara Sahakian ◽  
Christianne Lane ◽  
...  
Keyword(s):  
Endoscopic Retrograde Cholangiopancreatography ◽  
Acute Cholangitis ◽  
Optimal Timing ◽  
Endoscopic Retrograde

scholarly journals Partially Covered Self-Expandable Metal Stents versus Polyethylene Stents for Malignant Biliary Obstruction: A Cost-Effectiveness Analysis

2015 ◽  
Vol 29 (7) ◽  
pp. 377-383 ◽  
Author(s):  
Alan N Barkun ◽  
Viviane Adam ◽  
Myriam Martel ◽  
Khalid AlNaamani ◽  
Peter L Moses
Keyword(s):  
Cost Effectiveness ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Biliary Obstruction ◽  
Cost Effectiveness Analysis ◽  
Malignant Biliary Obstruction ◽  
Sensitivity Analyses ◽  
Metal Stents ◽  
Endoscopic Drainage ◽  
Endoscopic Retrograde ◽  
Effectiveness Analysis

BACKGROUND/OBJECTIVE: Partially covered self-expandable metal stents (SEMS) and polyethylene stents (PES) are both commonly used in the palliation of malignant biliary obstruction. Although SEMS are significantly more expensive, they are more efficacious than PES. Accordingly, a cost-effectiveness analysis was performed.METHODS: A cost-effectiveness analysis compared the approach of initial placement of PES versus SEMS for the study population. Patients with malignant biliary obstruction underwent an endoscopic retrograde cholangiopancreatography to insert the initial stent. If the insertion failed, a percutaneous transhepatic cholangiogram was performed. If stent occlusion occurred, a PES was inserted at repeat endoscopic retrograde cholangiopancreatography, either in an outpatient setting or after admission to hospital if cholangitis was present. A third-party payer perspective was adopted. Effectiveness was expressed as the likelihood of no occlusion over the one-year adopted time horizon. Probabilities were based on a contemporary randomized clinical trial, and costs were issued from national references. Deterministic and probabilistic sensitivity analyses were performed.RESULTS: A PES-first strategy was both more expensive and less efficacious than an SEMS-first approach. The mean per-patient costs were US$6,701 for initial SEMS and US$20,671 for initial PES, which were associated with effectiveness probabilities of 65.6% and 13.9%, respectively. Sensitivity analyses confirmed the robustness of these results.CONCLUSION: At the time of initial endoscopic drainage for patients with malignant biliary obstruction undergoing palliative stenting, an initial SEMS insertion approach was both more effective and less costly than a PES-first strategy.

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