Clinical Value Analysis Of PTGD Before ERCP In Patients With Choledocholithiasis Associated With Acute Cholangitis

Purpose: The purpose of this study was to investigate the clinical value of early PTGD treatment before ERCP in patients with choledocholithiasis associated with acute cholangitis,and on this basis to explore the correlation between PTGD and choledocholithiasis recurrence after removal of ERCP choledocholithiasis.Methods: The study population included 72 patients who first came to our hospital for PTGD/ERCP for choledocholithiasis with acute cholangitis and were divided into two groups based on whether they received PTGD before ERCP or not: those who received two stages of PTGD followed by elective ERCP and those who received ERCP alone.We conducted a comparative study on the demographic characteristics and preoperative and postoperative clinical data of the two groups of patients,in order to explore the clinical value of early PTGD treatment before ERCP.Logistic regression was used to analyze the correlation between early PTGD treatment before ERCP and choledocholithiasis recurrence after removal of ERCP choledocholithiasis in patients with acute cholangitis.Results: 1.The levels of direct bilirubin and indirect bilirubin in the PTGD+ERCP group were significantly lower than those in the ERCP group after PTGD,and the difference between the two groups was statistically significant(P < 0.05);The levels of WBC and NEUT in the PTGD+ERCP group were significantly higher than those in the ERCP group before PTGD(P < 0.05),but there was no significant difference between the two groups after PTGD(P > 0.05).2.The incidence of biliary pancreatitis after ERCP in PTGD+ERCP group was lower than that in ERCP alone group,and the difference between the two groups was statistically significant(P = 0.025 < 0.05).3.Early PTGD treatment before ERCP can reduce the risk of choledocholithiasis recurrence in patients with acute cholangitis after ERCP surgery(OR: 10.817;95%CI: 1.479-79.100;P = 0.019< 0.05).4.Diabetes mellitus(OR: 9.123;95%CI: 1.628-51.131;P = 0.012 < 0.05)was positively correlated with choledocholithiasis recurrence after ERCP in patients with acute cholangitis.Conclusion: For patients with choledocholithiasis associated with acute cholangitis,both PTGD and ERCP can achieve biliary drainage and control infection,but compared with ERCP,the therapeutic effect of PTGD is better.PTGD enables patients to survive the acute phase of the disease more smoothly,and ERCP therapy can be performed after the patient’s overall condition improves,making ERCP an elective surgery and thus improving the safety of the surgery.PTGD can reduce the incidence of biliary pancreatitis in patients with choledocholithiasis associated with acute cholangitis after ERCP surgery and the risk of choledocholithiasis recurrence after ERCP surgery.However,the clinical value of routine PTGD therapy before ERCP in patients with choledocholithiasis and acute cholangitis remains to be further explored.Diabetes mellitus is an independent risk factor for choledocholithiasis recurrence in patients with acute cholangitis after ERCP surgery.