Effectiveness Of One-Step Ercp Procedure In Treating Patients With Non-Severe Acute Calculous Cholangitis

This study aimed to evaluate the efficiency of one-step endoscopic retrograde cholangiopancreatography (ERCP) for treatment of patients with non-severe acute calculous cholangitis. A total of 105 patients, between 2014 and 2016, were randomly assigned into an emergency lithotomy group (EL group, 44) and selective lithotomy group (SL group, 61). All patients were treated with intravenous antibiotics after each ERCP procedure. Indicators, such as age and gender of the patients, number of CBD stones, diameter of the largest CBD stone, diameter of the CBD, sum operation time of ERCP performance, papilla disposal techniques, interval to WBC normalization, ERCP-related complication rate, and length of stay (LOS) in hospital, were compared between the two groups. Preoperative diagnosis and severity assessment of cholangitis was performed according to criteria recommended in the 2013 Tokyo Guidelines. Results showed no significant differences between the EL and SL group regarding the following variables, mean age, gender proportion, diameter of the largest stone and CBD, pre-ERCP WBC levels, percentage of cases with unstable hemodynamics, percentage of cases with papilla stone impaction, percentage of lithotripsy, and incidence of complications. However, a lower percentage of cases with a single stone (24.6% vs. 43.2%), longer duration of ERCP procedure (40.5 +/- 9.8 vs. 36.3 +/- 6.5 min), interval to WBC normalization (5.9 +/- 3.4 vs. 3.9 +/- 2.4 d), and LOS (9.1 +/- 3.6 vs. 7.3 +/- 2.2 d) were found in the SL group than the EL group. Diameter of the largest stone and CBD were statistically correlated with time of ERCP procedure (R=0.61, P<0.001; R=0.56, P<0.001). Application of lithotripsy significantly prolonged the duration of ERCP procedure (lithotripsy vs. not: 47.8 +/- 10.3, 36.7 +/- 7.0 min, P<0.05), while the diameter of the largest stone was the only statistical factor affecting duration of the ERCP procedure. One-step ERCP shortened recovery times, hospital stays, and operation duration. This was suitable for patients with non-severe acute calculous cholangitis, especially in patients with single relatively small stones.