P55 Timing of ERCP and outcomes in patients with acute gallstone cholangitis graded by severity

IntroductionThe optimal timing of endoscopic retrograde cholangiopancreatography (ERCP) in the management of acute gallstone cholangitis is not known. Severity of cholangitis can be classified with the Tokyo 2018 criteria. The European Society of Gastrointestinal Endoscopy published guidance on the recommended timing of ERCP guided by the severity of cholangitis; stipulating that biliary drainage should occur within the following timeframes: mild – elective, moderate – within two to three days and severe – as soon as possible. We aim to analyse the clinical outcomes of patients with acute cholangitis who have been admitted to a tertiary hepatobiliary centre when categorised by severity.MethodsA retrospective analysis of patients admitted to our hospital with acute cholangitis over a 3 year period from June 2016 to June 2019 was carried out. Patients were identified via coding department and endoscopy reporting tool. All patients met 2018 Tokyo criteria for definite cholangitis. Only patients with choledocholithiasis without concurrent biliary pathology were included for analysis. Case notes and electronic database interrogation yielded information for calculation of severity of cholangitis. Statistical analyses were carried out with Kruskall-Wallis test or chi-squared tests where appropriate.ResultsA total of 218 patients were identified and 199 patients who underwent ERCP during the index admission were included for analysis. There was a female preponderance (55.8%) and the median age was 73 years (range 19–96). The proportion of severity of cholangitis at presentation was as follows: 51.3% (n=102) mild, 32.6% (n=65) moderate and 16.1% (n=32) severe. The median time taken from admission to ERCP for the 199 patients was 4.8 days (mild 4.4 days, moderate 5.4 days, severe 4.8 days; p=0.31). The median length of stay 7.8 days (mild 7.2 days, moderate 7.8 days, severe 9.5 days; p=0.009). 31.3% of patients with severe cholangitis (n=10) were admitted to intensive care (ITU); 6 of whom required urgent ERCP. For patients with severe cholangitis, the median time in those who required urgent ERCP was 1.5 days vs 5.6 days in those who did not. The overall 30-day all-cause mortality amongst the 199 patients was 1% (n=2; both with severe cholangitis who underwent successful ERCP at 23 hours and 42 hours). 30-day all-cause mortality was 6.3% in the severe group and 0% in both mild and moderate groups (p=0.005).ConclusionsOur results demonstrate no difference in timing