Clinical Analysis of Acute Cholangitis; Prognostic Factors for Emergency Endoscopic Retrograde Cholangiopancreatography

Kim, Gyun Moo; Lee, Kyung Won

Abstract

PURPOSE: Acute cholangitis is a life-threatening biliary complication. Medical treatment is the first-line therapy in patients with acute cholangitis, but those who fail to respond to antibiotic treatment require urgent biliary decompression. This study was undertaken in order to determine predictive factors for emergency endoscopic retrograde cholangiopancreatography (ERCP).
METHODS
This was a retrospective observation study with data from Daegu Catholic University Hospital, Emergency Department (ED). Between Jan 2005 and Dec 2007, 317 patients were enrolled into this study. Inclusion criteria for patients were a final diagnosis: acute cholangitis, and an ERCP from ED visit. We defined emergency ERCP, as ERCP done within 24 hours of an ED visit. We analyzed the medical data by using SPSS 14.0 and compared the Emergency ERCP group to the Elective (Non emergency) ERCP group with regard to age, sex, vital signs on ED, symptom onset time, mortality, and various laboratory tests.
RESULTS
Access to ED and laboratory tests (such as aspartate transaminase (AST) and alanine transaminase (ALT) were factors that showed statistically significant differences between the ERCP group (n=289) and Elective ERCP group (n=28) by the Chi-square test and the t-test by each. There were no statistical differences in other factors by independent t test or Chi-square test. Multiple logistic regression showed access to ED; a laboratory test such as AST were predictive factors for emergency ERCP.
CONCLUSION
The result of this study indicates that the EP (Emergency physician) should pay attention to the acute cholangitis patients who visit the ED with an abnormal laboratory test. In the timely consultation to the endoscopist, EP plays a key role in the treatment of acute cholangitis.