» Articles » PMID: 34441903

Clinical Outcomes of Early Endoscopic Transpapillary Biliary Drainage for Acute Cholangitis Associated with Disseminated Intravascular Coagulation

Overview
Journal J Clin Med
Specialty General Medicine
Date 2021 Aug 27
PMID 34441903
Citations 2
Authors
Affiliations
Soon will be listed here.
Abstract

Acute cholangitis (AC) is often associated with disseminated intravascular coagulation (DIC), and endoscopic transpapillary biliary drainage (EBD) under endoscopic retrograde cholangiopancreatography (ERCP) is a treatment of choice. However, no evidence exists on the outcomes of EBD for AC associated with DIC. Therefore, we retrospectively evaluated the treatment outcomes of early EBD and compared endoscopic biliary stenting (EBS) and endoscopic nasobiliary drainage (ENBD). We included 62 patients who received early EBD (EBS: 30, ENBD: 32) for AC, associated with DIC. The rates of clinical success for AC and DIC resolution at 7 days after EBD were 90.3% and 88.7%, respectively. Mean hospitalization period was 31.7 days, and in-hospital mortality rate was 4.8%. ERCP-related adverse events developed in 3.2% of patients (bleeding in two patients). Comparison between EBS and ENBD groups showed that the ENBD group included patients with more severe cholangitis, and acute physiology and chronic health evaluation II score, systemic inflammatory response syndrome score, and serum bilirubin level were significantly higher in this group. However, no significant difference was observed in clinical outcomes between the two groups; both EBS and ENBD were effective. In conclusion, early EBD is effective and safe for patients with AC associated with DIC.

Citing Articles

Clinical Advances in the Diagnosis and Treatment of Biliary Tract Diseases.

Matsubara S J Clin Med. 2023; 12(6).

PMID: 36983283 PMC: 10052998. DOI: 10.3390/jcm12062282.


Critically-Ill Patients with Biliary Obstruction and Cholangitis: Bedside Fluoroscopic-Free Endoscopic Drainage versus Percutaneous Drainage.

Liao Y, Lin W, Tsai H, Chen C, Tung C, Yang S J Clin Med. 2022; 11(7).

PMID: 35407477 PMC: 8999535. DOI: 10.3390/jcm11071869.

References
1.
Kienast J, Juers M, Wiedermann C, Hoffmann J, Ostermann H, Strauss R . Treatment effects of high-dose antithrombin without concomitant heparin in patients with severe sepsis with or without disseminated intravascular coagulation. J Thromb Haemost. 2006; 4(1):90-7. DOI: 10.1111/j.1538-7836.2005.01697.x. View

2.
Suetani K, Okuse C, Nakahara K, Michikawa Y, Noguchi Y, Suzuki M . Thrombomodulin in the management of acute cholangitis-induced disseminated intravascular coagulation. World J Gastroenterol. 2015; 21(2):533-40. PMC: 4292285. DOI: 10.3748/wjg.v21.i2.533. View

3.
Simmons D, Petersen B, Gostout C, Levy M, Topazian M, Baron T . Risk of pancreatitis following endoscopically placed large-bore plastic biliary stents with and without biliary sphincterotomy for management of postoperative bile leaks. Surg Endosc. 2007; 22(6):1459-63. DOI: 10.1007/s00464-007-9643-8. View

4.
Warren B, Eid A, Singer P, Pillay S, Carl P, Novak I . Caring for the critically ill patient. High-dose antithrombin III in severe sepsis: a randomized controlled trial. JAMA. 2001; 286(15):1869-78. DOI: 10.1001/jama.286.15.1869. View

5.
Saito H, Maruyama I, Shimazaki S, Yamamoto Y, Aikawa N, Ohno R . Efficacy and safety of recombinant human soluble thrombomodulin (ART-123) in disseminated intravascular coagulation: results of a phase III, randomized, double-blind clinical trial. J Thromb Haemost. 2006; 5(1):31-41. DOI: 10.1111/j.1538-7836.2006.02267.x. View