ERCP IN PATIENTS WITH ACUTE CHOLECYSTITIS AND HIGH SURGICAL RISK REDUCES READMISSION RATE

Aims:

Primary aim was analyzing causes of readmission after an AC in not surgical candidates and knowing the influence of ERCP with sphincterotomy on the readmission rate. Secondary aim was analyzing mortality rates.

Methods:

A Retrospective analysis was performed. All patients admitted in the hospital between 2012 and 2013 with diagnosis of acute cholecystitis and not surgical candidates were included in the study. Mortality and readmissions in the following 5 years were collected.

Results:

Following table show baseline characteristics, mortality and readmission rates.

Tab. 1:

Baseline characteristics, mortality and readmission rates

116 patients admitted with AC	54 men (47%)/62 women (53%)
Mean age	84,8 (60 – 102)
Associated biliary pathology	13 choledocholithiasis/8 pancreatitis/2 choledocholithiasis + pancreatitis
Mortality	- during hospital admission 13/116 (11.2%)//– After 5 years 69/103 (67%) *For biliary cause 3/103 (2.9%)
Readmissions in 5 years	- Biliary pathology 35 (15.5%)//– Other medical reasons 190 (84.5%)

93 patients with AC and no other biliary pathology: 8 underwent biliary drainage (6 percutaneous drainage and 2 ERCP), one was readmitted due to cholecystitis (16.7%); 85 underwent antibiotic therapy without biliary drainage, 23 (27%) were readmited due biliary pathology (6 cholecystitis, 8 choledocholithiasis, 5 pancreatitis, 2 biliary colic and 2 gallbladder neoplasms).

15 patients had AC and choledocholithiasis: ERCP was performed in 12, 1 was readmitted due to choledocholithiasis (6.7%). In 3, ERCP was not performed, one died and anotherone was re-admitted (50%) due to choledocholithiasis.

8 patients with AC and pancreatitis: 2 underwent ERCP, none had to be readmitted (0%). 6 received only medical treatment, 2 died, 1 was readmitted for choledocholithiasis (25%).

Conclusions:

Patients with AC and cholecystectomyy contraindication because of high surgical risk have high rates of readmission and non-biliary cause mortality. Patients with AC and AC+choledocolitiasis who underwent ERCP and sphyncterotomy presented lower rates of biliary readmissions.