Does Timing of ERCP Matter? – A Prospective Single-Center Study
DOI:
https://doi.org/10.61919/g40z7r79Keywords:
Acute cholangitis, ERCP timing, biliary obstruction, TG18 severity, mortality, prospective cohort studyAbstract
Background: Acute cholangitis is a potentially fatal infection resulting from biliary obstruction. Early endoscopic retrograde cholangiopancreatography (ERCP) has been proposed to improve outcomes, but the optimal timing and its impact across different severity grades remain uncertain, particularly in resource-limited settings. Objective: To evaluate the effect of ERCP timing on clinical outcomes in patients with acute cholangitis stratified by Tokyo Guidelines 2018 (TG18) severity grades. Methods: This prospective observational cohort study enrolled 158 patients diagnosed with acute cholangitis at Dr. Ruth K. M. Pfau Civil Hospital Karachi. Participants were categorized as early (≤48 hours; n=79) or late (>48 hours; n=79) ERCP groups. Primary outcome was length of hospital stay; secondary outcomes included 30-day and in-hospital mortality, ICU admission, organ failure, and ERCP-related complications. Statistical analysis used t-tests, Chi-square, and multivariate logistic regression with p<0.05 considered significant. Results: Early ERCP significantly reduced 30-day mortality (5.1% vs 15.2%, p=0.035), hospital stay (5.9±2.1 vs 9.5±3.2 days, p<0.001), ICU admission (8.9% vs 22.8%, p=0.015), and multiorgan dysfunction (12.7% vs 27.8%, p=0.019). The mortality benefit was confined to severe TG18 grade (8.3% vs 41.7%, p=0.008). Conclusion: ERCP within 48 hours confers substantial survival and recovery benefits, especially in severe cholangitis, supporting early biliary decompression as a critical management priority.
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Copyright (c) 2025 Erum Anwar, Sidra Waqar Qureshi, Abdul Wasay, Muhammad Zubair, Akram Rajput (Author)
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