Influence Of ERCP Timing Selection On Curative Effect In Patients With Common Bile Duct Stones With Moderate Acute Cholangitis

Background:Acute cholangitis(AC)is a common biliary infectious disease.Biliary tract obstruction caused by common bile duct stones(CBDS)is more than 50%,and the prognosis and outcome of patients with different degrees of AC are different.Endoscopic retrograde cholangiopancreatography(ERCP)is a recognized first-line clinical treatment.As for when to carry out ERCP intervention,the European Society of gastroenteroendoscopy(ESGE)pointed out through a large number of meta-analysis that endoscopic drainage should be carried out within 12 hours for severe acute cholangitis;Moderate acute cholangitis was performed at 48-72 hours;Patients with mild acute cholangitis was selective.Domestic researchers have also completed some confirmatory studies.Due to the characteristics of severe acute cholangitis,most studies focus on the exploration of endoscopic intervention time of severe acute cholangitis.According to ESGE,the timing of ERCP treatment for CBDS patients with moderate cholangitis is relatively sufficient compared with severe patients.However,moderate acute cholangitis can develop to severe.If the timing of treatment is delayed,the progression of the disease to severe will bring adverse outcomes.Therefore,we should pay more attention to the diagnosis and treatment of patients with moderate AC.Objective:To study the effects of different ERCP intervention timing on the changes of laboratory indexes before and after treatment,the occurrence of postoperative adverse events,hospitalization expenses and hospitalization time of patients with common bile duct stones with moderate acute cholangitis.Method:XThe medical records of our hospital from 2014 to 2021 were collected.According to the inclusion and exclusion criteria,the relevent information of patients with common bile duct stones with moderate acute cholangitis was retrospectively screened.A total of 1475 patients were collected,all of whom received ERCP in our hospital from January 1,2014 to December 31,2021.The intervention time of ERCP was divided into four groups,including 219 people who received ERCP within 12 hours,530 people who received ERCP within 12-48 hours,625 people who received ERCP within 48-72 hours and 101 people who received ERCP more than 72 hours.Collect general information of all enrolled patients;Preoperative and postoperative body temperature;Blood routine examination,liver and kidney function,pancreatic function,infection index and other relevant laboratory indexes;The number of adverse events such as postoperative pancreatitis,cholecystitis,bleeding and perforation;Length of stay and expenses.By analyzing the prognosis and outcome of patients to guide the choice of operation time.Result:1.Before the treatment of patients with CBDS with moderate AC,there was no significant difference in laboratory indexes among ERCP intervention groups(P>0.05).2.After the treatment of patients with CBDS with moderate AC among the groups of different timing of ERCP were significant differences in postoperative WBC,NEUT,PCT,CRP,HB,PLT,ALT,TBi L,serum amylase,serum lipase(P<0.05);There was no significant difference between the timing of ERCP and the levels of ALP,AST,RBC,ALB and SCR(P>0.05).3.After treatment,TBi L in each group was 30.900(6.9,51.6)in ≤12h group,36.650(9.7,64.8)in 12-48 h group,38.200(20.8,58.9)in 48-72 h group and 34.400(26.7,47.5)in >72h group.TBi L in ≤12h group was the smallest in the four groups after treatment,and decreased the most significantly after treatment.The postoperative ALT was 90.000(18.7,228.4)in ≤12h group,162.500(98.8,236.3)in 12-48 h group,179.000(71.0,247.0)in 48-72 h group and 98.000(68.0,247.0)in >72h group.ALT reduced the most during surgical intervention within 12 h.The postoperative GGT was 144.000(98.0,262.0)in the≤12h ERCP group,195.500(86.8,352.5)in the 12-48 h group,185.000(91.0,342.5)in the 48-72 h group and 208.000(93.0,418.5)in the >72h group.The postoperative GGT reduced the most in the operation group within 12 h.4.The mean values of WBC,PCT,CRP and NEUT in the ≤12h group were 6.92,0.70,44.79 and 7.78.The mean value of each index was the smallest in the four intervention groups,and the improvement was the most obvious.5.The timing of ERCP had a significant effect on the incidence of postoperative pancreatitis,cholecystitis and bleeding(P<0.05),but no significant difference with the incidence of perforation and death(P>0.05).By comparing the percentage,the incidence of postoperative pancreatitis and cholecystitis increased gradually with the extension of intervention time.The incidence of moderate and severe pancreatitis increased significantly in the intervention group >72 hours;The incidence of postoperative bleeding in each group was 3.65% in ≤12h group,2.08% in 12-48 h group,2.40% in 48-72 h group and 5.94% in >72h group.6.There were significant differences in the length of hospital stay and cost at different operation times(P<0.05).With the delay of intervention time,both the length and the cost of hospitalization showed a gradual increasing trend.There was a difference of 10,000 yuan between the ≤12h group and the >72h group.conclusion:1.The TBi L,GGT,ALT and other indexes of CBDS patients with moderate AC were significantly decreased after ERCP within 12 hours.2.The WBC,PCT,CRP,NEUT and other infection indexes of CBDS patients with moderate AC were significantly decreased after ERCP within 12 hours.3.With the delay of ERCP intervention time,the incidence of postoperative pancreatitis and cholecystitis increased gradually.The incidence of postoperative bleeding was low within 12-72 hours and high over 72 hours.4.With the delay of ERCP intervention time,the length and the cost of hospitalization showed a gradual increasing trend.