AI Article Synopsis
- The study aimed to assess the safety of immediate endoscopic sphincterotomy (EST) for acute suppurative cholangitis (ASC) caused by gallstones compared to elective EST.
- Patients were divided into two groups: immediate EST and delayed EST due to certain health conditions, with all procedures supervised by an experienced specialist.
- Both immediate and elective ESTs were successful with no complications, suggesting that immediate EST can be safe under specific conditions and can be performed by trainees with proper supervision.
Article Abstract
Aim: To examine the safety of immediate endoscopic sphincterotomy (EST) in patients with acute suppurative cholangitis (ASC) caused by choledocholithiasis, as compared with elective EST.
Methods: Patients with ASC due to choledocholithiasis were allocated to two groups: Those who underwent EST immediately and those who underwent EBD followed by EST 1 wk later because they were under anticoagulant therapy, had a coagulopathy (international normalized ratio > 1.3, partial thromboplastin time greater than twice that of control), or had a platelet count < 50000 × 10(3)/μL. One of four trainees [200-400 cases of endoscopic retrograde cholangiopancreatography (ERCP)] supervised by a specialist (> 10000 cases of ERCP) performed the procedures. The success and complication rates associated with EST in each group were examined.
Results: Of the 87 patients with ASC, 59 were in the immediate EST group and 28 in the elective EST group. EST was successful in all patients in both groups. There were no complications associated with EST in either group of patients, although white blood cell count, C-reactive protein, total bilirubin, and serum concentrations of liver enzymes just before EST were significantly higher in the immediate EST group than in the elective EST group.
Conclusion: Immediate EST can be as safe as elective EST for patients with ASC associated with choledocholithiasis provided they are not under anticoagulant therapy, or do not have a coagulopathy or a platelet count < 50000 × 10(3)/μL. Moreover, the procedure was safely performed by a trainee under the supervision of an experienced specialist.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4734977 | PMC |
| http://dx.doi.org/10.4253/wjge.v8.i3.180 | DOI Listing |
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