Urgent endoscopic retrograde cholangiopancreatography is not superior to early ERCP in acute biliary pancreatitis with biliary obstruction without cholangitis

<div><p>Acute pancreatitis is a common diagnosis worldwide, with gallstone disease being the most prevalent cause (50%). The American College of Gastroenterology recommends urgent endoscopic retrograde cholangiopancreatography (ERCP) (within 24 h) for patients with biliary pancreatitis accompanied by cholangitis. Most international guidelines recommend that ERCP be performed within 72 h in patients with biliary pancreatitis and a bile duct obstruction without cholangitis, but the optimal timing for endoscopy is controversial. We investigated the optimal timing for ERCP in patients with biliary pancreatitis and a bile duct obstruction without cholangitis, and whether performing endoscopy within 24 h is superior to performing it after 24 h. We analyzed the clinical data of 505 patients with newly diagnosed acute pancreatitis, from January 1, 2005 to December 31, 2014. We divided the patients into two groups according to the timing of ERCP: < 24 h (urgent) and 24–72 h (early).Among the 505 patients, 73 were diagnosed with biliary pancreatitis and a bile duct obstruction without cholangitis. The mean age of the patients was 55 years (range: 26–90 years). Bile duct stones and biliary sludge were identified on endoscopy in 45 (61.6%) and 11 (15.0%) patients, respectively. The timing of ERCP within 72 h was not associated with ERCP-related complications (<i>P</i> = 0.113), and the total length of hospital stay was not different between urgent and early ERCP (5.9 vs. 5.7 days, <i>P =</i> 0.174). No significant differences were found in total length of hospitalization or procedural-related complications, in patients with biliary pancreatitis and a bile duct obstruction without cholangitis, according to the timing of ERCP (< 24 h vs. 24–72 h).</p></div

Urgent endoscopic retrograde cholangiopancreatography is not superior to early ERCP in acute biliary pancreatitis with biliary obstruction without cholangitis

<div><p>Acute pancreatitis is a common diagnosis worldwide, with gallstone disease being the most prevalent cause (50%). The American College of Gastroenterology recommends urgent endoscopic retrograde cholangiopancreatography (ERCP) (within 24 h) for patients with biliary pancreatitis accompanied by cholangitis. Most international guidelines recommend that ERCP be performed within 72 h in patients with biliary pancreatitis and a bile duct obstruction without cholangitis, but the optimal timing for endoscopy is controversial. We investigated the optimal timing for ERCP in patients with biliary pancreatitis and a bile duct obstruction without cholangitis, and whether performing endoscopy within 24 h is superior to performing it after 24 h. We analyzed the clinical data of 505 patients with newly diagnosed acute pancreatitis, from January 1, 2005 to December 31, 2014. We divided the patients into two groups according to the timing of ERCP: < 24 h (urgent) and 24–72 h (early).Among the 505 patients, 73 were diagnosed with biliary pancreatitis and a bile duct obstruction without cholangitis. The mean age of the patients was 55 years (range: 26–90 years). Bile duct stones and biliary sludge were identified on endoscopy in 45 (61.6%) and 11 (15.0%) patients, respectively. The timing of ERCP within 72 h was not associated with ERCP-related complications (<i>P</i> = 0.113), and the total length of hospital stay was not different between urgent and early ERCP (5.9 vs. 5.7 days, <i>P =</i> 0.174). No significant differences were found in total length of hospitalization or procedural-related complications, in patients with biliary pancreatitis and a bile duct obstruction without cholangitis, according to the timing of ERCP (< 24 h vs. 24–72 h).</p></div

Study population enrolled in the present study.

<p>Among 505 patients with acute pancreatitis, 207 patients had a diagnosis of acute biliary pancreatitis. According to the exclusion criteria, a total of 73 patients were enrolled in the present study.</p

Characteristics of ERCP procedures performed in patients.

<p>Characteristics of ERCP procedures performed in patients.</p

Baseline characteristics.

<p>Baseline characteristics.</p

Hospitalization day and complications stratified by BISAP score^†.

<p>Hospitalization day and complications stratified by BISAP score^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0190835#t005fn004" target="_blank">†</a>}.</p

Baseline characteristics of subgroups.

<p>Baseline characteristics of subgroups.</p

Comparison of subgroups according to the location of the prior cancer in second PDAC.

<p>Comparison of subgroups according to the location of the prior cancer in second PDAC.</p

Kaplan-Meier analysis of overall survival (OS) according to subgroup.

<p>(A) First primary pancreatic ductal adenocarcinoma (1st PDAC) vs. second primary PDAC (2nd PDAC) in the whole cohort (n: 1606 vs. 110): median OS 11.8 vs. 12.3 months, p = 0.068 by log-rank test. (B) 1st PDAC vs. 2nd PDAC in patients who received curative surgery as initial treatment (n: 256 vs. 29): median OS 28.5 vs. 33.1 months, p = 0.860 by log-rank test. (C) 1st PDAC vs. 2nd PDAC in patients who received chemotherapy as initial treatment (n: 1094 vs. 66): median OS 10.7 vs. 10.8 months, p = 0.952 by log-rank test.</p

Cox proportional analysis for the contribution of clinical factors to overall survival.

<p>Cox proportional analysis for the contribution of clinical factors to overall survival.</p