Abstrak 
The Effectiveness of Emergency Endoscopic Retrograde Cholangiopancreatography in Patients with Severe Acute Cholangitis
Muhammad Begawan Bestari, Nenny Agustanti, Yelica Rachmat, Dolvy Girawan, Ali Djumhana, Juke Roslia Saketi, Siti Aminah
Universitas Padjadjaran, The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Volume 11, Number 3, December 2010
Bahasa Inggris
Universitas Padjadjaran, The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Volume 11, Number 3, December 2010
emergent ERCP, endoscopic stenting in difficult hilar biliary stricture, severe acute cholangitis
Background: Acute cholangitis varies in severity from a mild form responding to antibiotics alone to a severe from requiring urgent decompression of the biliary system. Management of acute biliary infections according to severity grade is also critical, because the urgency of treatment and patient outcomes differ according to the severity of the disease. The aim of this study was to assess the frequency, indications, yield and outcome of emergent endoscopy retrograde cholangiopancreatography (ERCP) in severe acute cholangitis patients. Method: Records of all cholangitis patients undergoing ERCP were reviewed over a six months period. Indications, findings, therapeutic interventions and survival were analyzed. Indications for urgent drainage were temperature greater than 38ÂșC, increasing abdominal pain, jaundice and any organ involvement. Results: Of 80 ERCPs, 19 (23.75%) were severe acute cholangitis patients underwent emergency ERCP. The common bile duct was the duct of interest in all patients and was cannulated in 100%. The most common findings were choledocholithiasis (42.1%) and pancreatic head cancer (42.1%), followed by cholangiocarcinoma (10.5%) and papil vater carcinoma (5.3%). There were 12 (63.2%) septic shock patients with systolic blood pressure less than 90 mmHg and heart rate greater than 90 beats/minute who required inotropic drugs. Endoscopic biliary drainage was performed using 8.5 F biliary stent (73.7%) or common bile duct (CDB) stones removal (26.3%). The overall 30 days mortality was 0. Conclusion: Emergency ERCP in severe acute cholangitis is associated with improvement of clinical and some laboratory parameters without a complication of acute pancreatitis. In cases of chIoledocholithiasis, it can be performed with stone extraction as well as stent insertion