A recent study reported that a bedside endoscopic technique achieved a 100% technical success rate in treating critically ill patients with severe acute cholangitis, using a radiation-free approach.
Researchers have introduced a radiation-free, bedside endoscopic approach for managing severe acute cholangitis (SAC) secondary to choledocholithiasis in intensive care unit (ICU) patients. This study, published in Scientific Reports, reported the outcomes of a one-stage endoscopic lithotomy and biliary drainage procedure performed on 30 critically ill patients.
The patient population had an average Acute Physiology and Chronic Health Evaluation score of 24.6 ± 6.4, with scores ranging from 13 to 38, reflecting the overall severity of their disease. Additionally, the average Sequential Organ Failure Assessment score was 11.9 ± 3.3, ranging from 3 to 18, indicating the patients' critical health status.
The intervention utilized a digital cholangioscope (DCS)-assisted endoscopic technique, which may reduce the challenges associated with ICU settings by facilitating successful stone removal and biliary drainage without the need for radiation or transportation to fluoroscopy-equipped facilities.
The average duration from ICU admission to the intervention was 7.6 ± 4.7 hours, with a range of 2 to 18 hours. From the onset of symptoms to the intervention, the average time was 35.5 ± 14.5 hours, ranging between 5 and 48 hours. The average time to obtain biliary access was 3.8 ± 4.5 minutes, with a range from 1.5 to 14 minutes. Visualization of the biliary system took an average of 10.2 ± 3.8 minutes, ranging from 6 to 38 minutes. The entire endoscopic procedure had an average duration of 31.6 ± 12.7 minutes, with times varying between 14 and 70 minutes. Only one case of mild pancreatitis was reported as a complication.
Following the procedure, the patients demonstrated significant improvements in clinical severity scores and laboratory parameters. The mean ICU stay was 8.7 days, with a total in-hospital stay averaging 14.5 days. In-hospital mortality was documented in three patients, with no occurrences of recurrent SAC or residual biliary stones at the 6-month follow-up. Two additional deaths occurred postdischarge caused by pneumonia and acute myocardial infarction.
In comparison to traditional endoscopic retrograde cholangiopancreatography (ERCP), the DCS-assisted technique resulted in several significant improvements. It led to a reduction in ICU stay duration (P = .043) and a shorter total hospitalization time (P < .001). Additionally, the in-hospital mortality rate was lower with the DCS-assisted approach (P = .021), and the 6-month mortality rate postdischarge was also significantly reduced (P = .032).
Postintervention, there were significant reductions in several laboratory parameters:
- leucocyte count (F = 10.220, P < .001)
- serum lactate (F = 32.200, P < .001)
- C-reactive protein (F = 24.740, P < .001)
- procalcitonin (F = 22.380, P < .001)
- serum total bilirubin (F = 23.640, P < .001)
- alanine transaminase (F = 20.410, P < .001)
- aspartate transaminase (F = 16.360, P < .001)
- serum creatinine (F = 8.611, P = .002).
This radiation-free bedside endoscopic technique may provide an alternative to traditional ERCP, with observed outcomes including reduced ICU and hospital stays, lower in-hospital mortality, and a decreased need for subsequent interventions. The findings suggested this approach could be considered in the management of SAC in ICU patients, where traditional methods may be impractical or pose additional risks.
Authors reported no conflict of interest.