No Association of Timing of Endoscopic Biliary Drainage with Clinical Outcomes in Patients with Non-severe Acute Cholangitis

Background Biliary drainage via endoscopic retrograde cholangiopancreatography (ERCP) is the first-line treatment for acute cholangitis. Despite the established effectiveness of urgent biliary drainage in patients with severe acute cholangitis, the indication of this procedure for non-severe acute cholangitis is controversial. Aims To assess the safety of elective drainage (≥ 12 h of admission) for non-severe acute cholangitis. Methods We retrospectively identified 461 patients with non-severe acute cholangitis who underwent endoscopic biliary drainage. Using linear regression models with adjustment for a variety of potential confounders, we compared elective versus urgent biliary drainage (< 12 h of admission) in terms of clinical outcomes. The primary outcome was the length of stay. Results There were 98 and 201 patients who underwent elective and urgent biliary drainage, respectively. The median length of stay was 11 days in both groups ( P = 0.52). The timing of ERCP was not associated with length of stay in the multivariable model ( P = 0.52). Secondary outcomes including in-hospital mortality and recurrence of cholangitis were not different between the groups. Conclusions Elective biliary drainage was not associated with worse clinical outcomes of non-severe acute cholangitis as compared to urgent drainage. Further investigation is warranted to justify the elective drainage for non-severe cholangitis.