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Delayed, failed ERCP led to poorer outcomes in patients with acute cholangitis

Patients with acute cholangitis who underwent delayed or unsuccessful endoscopic retrograde cholangiopancreatography were more likely to experience poor clinical outcomes and incur higher costs in a recent study.

In a retrospective analysis, researchers evaluated data from 90 patients with acute cholangitis who underwent endoscopic retrograde cholangiopancreatography (ERCP) between Jan. 1994 and June 2010. The timing and success of ERCP performance was assessed, with delayed ERCP defined as a procedure performed 72 hours or more after hospital admission, and failed ERCP as the inability to achieve biliary cannulation. Incidences of composite clinical outcomes that included ICU stays, in-hospital mortality and/or persistent organ failure were also observed.

ERCP was performed at a mean of 38.5 hours after admission, and was successful in 92% of cases. Patients had a mean hospital stay of 7 days, with a mean total cost of $24,206. Unsuccessful ERCP was associated with prolonged hospital stay (OR=52.5, P=.002) and higher hospitalization costs (OR=33.8, P=.004) at the 90th percentile via multivariate analysis. Delayed ERCP occurred in 14% of cases and was also associated with prolonged hospital stay (OR=19.8, P=.008) and higher costs (OR=11.3, P=.03).

Composite clinical outcomes were experienced by 23 patients and included eight in-hospital deaths, 19 ICU stays and 13 cases of persistent organ failure. Investigators observed associations between composite clinical outcomes and delayed ERCP (OR=7.8, P=.04), as well as with advanced age (OR=1.1, P=.01) and bilirubin levels (OR=1.36, P=.002) via multivariate analysis.

“In the current study, the timing of ERCP was a significant predictor of important clinical outcomes,” the researchers wrote. “... Delayed and failed ERCP are associated with prolonged and increased hospitalization cost,” the researchers wrote. “In addition, delayed ERCP is associated with composite end point (death or persistent organ failure or ICU stay).”

Disclosure: Researcher Mouen Khashab serves as a consultant for Boston Scientific.