Safety of immediate endoscopic sphincterotomy in acutesuppurative cholangitis caused by choledocholithiasis

• 作者: Hiroaki Saito Hironao Okubo Jin Kan Sai Ko Tomishima Ryo Kanazawa Shigeto Ishii Shuichiro Shiina Sumio Watanabe Tomoyasu Ito
• 来源期刊: 世界胃肠内镜杂志：英文版（电子版）
• 学科: 医学
• 关键词: ACUTE CHOLANGITIS COMPLICATIONS Endoscopicsphincterotomy
• 年，卷（期）: 2016,（3）
• 页码范围: 180-185
• 页数: 6页
• 分类号: R

摘要

AIM To examine the safety of immediate endoscopicsphincterotomy （EST） in patients with acute suppurativecholangitis （ASC） caused by choledocholithiasis, ascompared with elective EST.METHODS： Patients with ASC due to choledocholithiasiswere allocated to two groups： Those who underwent ESTimmediately and those who underwent EBD followed byEST 1 wk later because they were under anticoagulanttherapy, had a coagulopathy （international normalizedratio 〉 1.3, partial thromboplastin time greater thantwice that of control）, or had a platelet count 〈 50000× 103/μL. One of four trainees [200-400 cases of endoscopicretrograde cholangiopancreatography （ERCP）]supervised by a specialist （〉 10000 cases of ERCP）performed the procedures. The success and complicationrates associated with EST in each group were examined.RESULTS： Of the 87 patients with ASC, 59 were in theimmediate EST group and 28 in the elective EST group.EST was successful in all patients in both groups. Therewere no complications associated with EST in either groupof patients, although white blood cell count, C-reactive protein, total bilirubin, and serum concentrations of liverenzymes just before EST were significantly higher in theimmediate EST group than in the elective EST group.CONCLUSION： Immediate EST can be as safe as electiveEST for patients with ASC associated with choledocholithiasisprovided they are not under anticoagulanttherapy, or donot have a coagulopathy or a platelet count 〈 50000 ×103/μL. Moreover, the procedure was safely performed by atrainee under the supervision of an experienced specialist.