Clinical Outcomes of Early Endoscopic Transpapillary Biliary Drainage for Acute Cholangitis Associated with Disseminated Intravascular Coagulation

Acute cholangitis (AC) is often associated with disseminated intravascular coagulation (DIC), and endoscopic transpapillary biliary drainage (EBD) under endoscopic retrograde cholangiopancreatography (ERCP) is a treatment of choice. However, no evidence exists on the outcomes of EBD for AC associated with DIC. Therefore, we retrospectively evaluated the treatment outcomes of early EBD and compared endoscopic biliary stenting (EBS) and endoscopic nasobiliary drainage (ENBD). We included 62 patients who received early EBD (EBS: 30, ENBD: 32) for AC, associated with DIC. The rates of clinical success for AC and DIC resolution at 7 days after EBD were 90.3% and 88.7%, respectively. Mean hospitalization period was 31.7 days, and in-hospital mortality rate was 4.8%. ERCP-related adverse events developed in 3.2% of patients (bleeding in two patients). Comparison between EBS and ENBD groups showed that the ENBD group included patients with more severe cholangitis, and acute physiology and chronic health evaluation II score, systemic inflammatory response syndrome score, and serum bilirubin level were significantly higher in this group. However, no significant difference was observed in clinical outcomes between the two groups; both EBS and ENBD were effective. In conclusion, early EBD is effective and safe for patients with AC associated with DIC.

Download Full-text

Clinical impact of recombinant thrombomodulin administration on disseminated intravascular coagulation due to severe acute cholangitis (Recover‐AC study)

Journal of Hepato-Biliary-Pancreatic Sciences ◽

10.1002/jhbp.998 ◽

2021 ◽

Author(s):

Takeshi Ogura ◽

Takaaki Eguchi ◽

Kazunari Nakahara ◽

Kanno Yoshihide ◽

Shunsuke Omoto ◽

...

Keyword(s):

Disseminated Intravascular Coagulation ◽

Acute Cholangitis ◽

Clinical Impact ◽

Intravascular Coagulation ◽

Recombinant Thrombomodulin

Download Full-text

Association of Timing of Biliary Drainage with Clinical Outcomes in Severe Acute Cholangitis: A Retrospective Cohort Study

International Journal of General Medicine ◽

10.2147/ijgm.s315306 ◽

2021 ◽

Vol Volume 14 ◽

pp. 2953-2963

Author(s):

Yimiao Zhu ◽

Jiangfeng Tu ◽

Yu Zhao ◽

Jiyong Jing ◽

Zhiyuan Dong ◽

...

Keyword(s):

Cohort Study ◽

Clinical Outcomes ◽

Retrospective Cohort Study ◽

Biliary Drainage ◽

Retrospective Cohort ◽

Acute Cholangitis

Download Full-text

Clinicopathologic features and clinical outcomes of gastric cancer that initially presents with disseminated intravascular coagulation: A retrospective study

Journal of Gastroenterology and Hepatology ◽

10.1111/j.1440-1746.2010.06289.x ◽

2010 ◽

Vol 25 (9) ◽

pp. 1537-1542 ◽

Cited By ~ 15

Author(s):

Jiyoung Rhee ◽

Sae-Won Han ◽

Do-Youn Oh ◽

Seock-Ah Im ◽

Tae-You Kim ◽

...

Keyword(s):

Gastric Cancer ◽

Retrospective Study ◽

Clinical Outcomes ◽

Disseminated Intravascular Coagulation ◽

Clinicopathologic Features ◽

Intravascular Coagulation

Download Full-text

Sphincterotomy with endoscopic biliary drainage for severe acute cholangitis: a meta-analysis

Endoscopy International Open ◽

10.1055/s-0042-120412 ◽

2017 ◽

Vol 05 (02) ◽

pp. E103-E109 ◽

Cited By ~ 4

Author(s):

Tarek Sawas ◽

Noura Arwani ◽

Shadi Al Halabi ◽

John Vargo

Keyword(s):

Success Rate ◽

Biliary Drainage ◽

Meta Analysis ◽

Acute Cholangitis ◽

Endoscopic Drainage ◽

Endoscopic Biliary Drainage ◽

Significant Difference ◽

Obstructive Cholangitis ◽

Effective Drainage

Abstract Aims To investigate the role of endoscopic sphincterotomy (ES) with endoscopic biliary drainage (EBD) in acute severe obstructive cholangitis management by performing a meta-analysis of controlled trials. Method We searched PubMed and Embase for controlled studies that compared endoscopic drainage with ES versus Non-ES in acute obstructive cholangitis. Two reviewers selected the studies and extracted the data. Disagreement was addressed by a third reviewer. Heterogeneity of the studies was analyzed by Cochran’s Q statistics. A Mantel–Haenszel risk ratio was calculated utilizing a random effects model. Results Four controlled studies met our inclusion criteria with 392 participants (201 ES, 191 Non-ES). The outcomes were drainage insertion success rate, drainage effectiveness, post drainage pancreatitis, bleeding, procedure duration, perforation, cholecystitis, and 30-day mortality. Drainage insertion success rate was identical in both groups (RR: 1.00, 95 %CI% 0.96 – 1.04). Effective drainage was not significantly different (RR: 1.11, 95 %CI 0.73 – 1.7). There was no significant difference in the incidence of pancreatitis post EBD between the ES and Non-ES groups at 3 % and 4 %, respectively (RR: 0.73, 95 %CI 0.24 – 2.27). However, there was a significant increase in post EBD bleeding with ES compared to Non-ES (RR: 8.58, 95 %CI 2.03 – 36.34). Thirty-day mortality was similar between ES and Non-ES groups at 0.7 % and 1 %, respectively (RR: 0.5, 95 %CI 0.05 – 5.28). Conclusion Our findings show that EBD without ES is an effective drainage technique and carries less risk for post procedure bleeding. Patients who are critically ill and have coagulopathy should be spared from undergoing ES in the acute phase.

Download Full-text

Clinical Characteristics and Risk Factors of Disseminated Intravascular Coagulation in Patients with COVID-19

10.21203/rs.3.rs-73616/v1 ◽

2020 ◽

Author(s):

Meng Jin ◽

Xinying Yue ◽

Shanshan Zhang ◽

Yanan Wang ◽

Zequn Lu ◽

...

Keyword(s):

Risk Factors ◽

Clinical Outcomes ◽

Disseminated Intravascular Coagulation ◽

Demographic Data ◽

Treatment Strategies ◽

Intravascular Coagulation ◽

Factors Associated ◽

Standardized Treatment ◽

Laboratory Examinations ◽

Coagulation Dysfunction

Abstract Background: Coronavirus disease 2019 (COVID-19) has spread globally. However, the association between COVID-19 and disseminated intravascular coagulation (DIC) has been scarcely addressed. We aimed to systematically characterize the clinical features and examine risk factors for DIC development in COVID-19 patients.Methods: In this single-centered, retrospective, and observational study, all patients with DIC (N=59) and 270 patients without DIC were matched by propensity score matching based on age, sex, and comorbidities. Demographic data, symptoms, radiological, laboratory examinations, and clinical outcomes were compared between patients with and without DIC. Furthermore, univariable and multivariable logistic regression were used to explore the risk factors associated with DIC development in COVID-19 patients.Results: Higher proportion of patients with DIC and COVID-19 (54 of 59 [91·53%]) developed into death than non DIC patients (58 of 270 [21·48%]). Patients with DIC presented aggravated inflammation responses, liver damage, and especially coagulation dysfunction. Moreover, in addition to previously reported coagulation-related markers, such as FDP, D-dimer, and platelet, we also identified several novel risk factors associated with DIC development, including decreased fibrinogen (OR=0·476, 95%CI=0·380-0·596, P<0·0001) and ALB (0·901, 0·845- 0·961, P=0·0015), and elevated IL-6 (1·010, 1·005-1·015, P=0·00017) and TNF-α (1·053, 1·016-1·091, P=0·0045).Conclusions: Patients with DIC and COVID-19 were predisposed to poor clinical outcomes. These risk factors identified may be helpful for early surveillance of disease progression and making standardized treatment strategies.

Download Full-text