Factors Associated With Post-Endoscopic Retrograde Cholangiopancreatography Cholangitis in Patients Undergoing Endoscopic Stone Extraction at a Japanese Tertiary Care Center

Abstract

Aim: Endoscopic retrograde cholangiopancreatography (ERCP) plays an important role in the management of patients with pancreaticobiliary disorders, including cholangitis. Although complications of ERCP can develop even when skilled physicians perform the procedure, there are few studies on the association between endoscopic stone extraction and post-ERCP cholangitis. Materials and Methods: The present report is of a retrospective cohort study of patients with choledocholithiasis and post-ERCP cholangitis. Clinical, microbiological, and procedural data were collected from the patients’ electronic medical records. The relationship between each clinical feature and post-ERCP cholangitis was analyzed using univariate and multivariate logistic regression analysis. Results: Of 376 patients with acute cholangitis due to choledocholithiasis, 200 consecutive patients meeting the inclusion criteria were identified. Among these, 23 (11.5%) received the diagnosis of post-ERCP cholangitis. In multivariate analysis, a duration of ≥11 days from biliary drainage to endoscopic stone extraction (adjusted odds ratio [aOR]: 8.57; 95% confidence interval [CI], 2.68-27.50) and the use of endoscopic papillary balloon dilation (aOR 6.04; 95% CI, 1.88-19.40) were identified as independent risk factors of post-ERCP cholangitis. Conclusions: The risk of post-ERCP cholangitis can be reduced by performing endoscopic stone extraction as soon as the patient achieves clinical stability after biliary stent insertion and by using endoscopic sphincterotomy instead of endoscopic papillary balloon dilation.