A Comparative Analysis Of Two Endoscopic Treatments For Acute Cholangitis Of Different Degrees

Objective Through retrospective analysis of ERCP treatment data of patients with different degrees of acute cholangitis complicated with bile duct stones,stratified comparison was made between ENBD treatment alone and biliary tract lithotripsy at the same time(EST,EPBD,endoscopic basket lithotripsy,etc.)+ ENBD treatment in postoperative infection control,removing jaundice,liver function recovery,hospitalization time,hospitalization costs,incidence of complications,etc.In order to provide clinical reference for the treatment of acute cholangitis by individualized endoscopy.Methods According to the diagnosis of acute cholangitis by TG18 and the assessment of its severity,from January 2011 to January 2018,the subjects of study were selected from patients undergoing ERCP for acute cholangitis complicated with bile duct stones in the Department of Hepatobiliary Surgery,General Hospital of Ningxia Medical University.According to the assessment of patients’ admission,the patients were divided into three groups: mild,moderate and severe.To compare the differences between the two group of blood biochemical indexes(WBC,NEUT%,PLT,TBil,DBil,ALB,ALT,AST,ALP,GGT),operation opportunity,operation time,hospitalization time,hospitalization costs and complication rate.Results By comparing the endoscopic treatment of mild acute cholangitis between two groups,the onset time of stone removal + ENBD group was shorter than that of ENBD group,and the operation time of stone removal + ENBD group was longer than that ofENBD group,the difference between the two groups were statistically significant(P < 0.05);For moderate acute cholangitis,oblique variance analysis was used to adjust the baseline biochemical indicators of admission blood.It is concluded that WBC,TBIL,DBIL and ALT in the stone removal + ENBD group are lower than those in the ENBD group on the first day after operation,PLT is larger than those in the ENBD group on the first day after operation,and hospitalization costs in the stone removal + ENBD group are higher than those in the ENBD group alone,with significant differences between the two groups(P < 0.05).For moderate acute cholangitis,the results showed that WBC was smaller on the first day after operation and ALB was larger on the first day after operation in the group of stone removal + ENBD than that in the group of ENBD alone.There were significant differences between the two groups(P < 0.05).For severe acute cholangitis patients with severe coagulation dysfunction before operation in ENBD group was significantly higher than that in stone removal + ENBD group,the difference between the two groups was statistically significant(P < 0.05).Conclusion 1.For the endoscopic treatment of mild acute cholangitis,although there is no significant difference in the short-term therapeutic effect and the incidence of complications between the two groups,the concurrent lithotripsy may avoid the second lithotripsy treatment and reduce the hospitalization time and cost in general;2.For the endoscopic treatment of moderate acute cholangitis,the effect of lithotripsy + ENBD group is better than that of ENBD group in infection control,reduction of jaundice and recovery of liver function.It is also possible to avoid secondary lithotripsy,and there is no significant difference in the incidence of recent complication;3.Endoscopic treatment of severe acute cholangitis should be based on ENBD drainage only,and then be treated with lithotripsy after the recovery of coagulation function and shock correction.