Endoscopic biliary drainage for severe acute cholangitis
| Autor: | John Wong, Kok-tjang You, Edward C. S. Lai, Sheung Tat Fan, Eliza S. Y. Tan, Chung Mau Lo, Francis P. T. Mok |
|---|---|
| Rok vydání: | 1992 |
| Předmět: |
Adult
Male medicine.medical_specialty Cholangitis Decompression Gallstones Endoscopy Gastrointestinal law.invention Sphincterotomy Endoscopic Surgical decompression Endoscopic drainage Postoperative Complications Randomized controlled trial Emergency surgery law Pregnancy Bile Humans Medicine Initial treatment Prospective Studies Drainage Prospective cohort study Aged Aged 80 and over Advanced and Specialized Nursing Biliary drainage medicine.diagnostic_test business.industry Suppurative cholangitis Gastroenterology General Medicine Middle Aged Prognosis Endoscopy Surgery Clinical trial Pregnancy Complications Biliary tract Acute Disease Female Emergencies business |
| Zdroj: | Gastroenterology Nursing. 15:137 |
| ISSN: | 1042-895X |
| DOI: | 10.1097/00001610-199212000-00016 |
| Popis: | Emergency surgery for patients with severe acute cholangitis due to choledocholithiasis is associated with substantial morbidity and mortality. Because recent results suggested that emergency endoscopic drainage could improve the outcome of such patients, we undertook a prospective study to determine the role of this procedure as initial treatment.During a 43-month period, 82 patients with severe acute cholangitis due to choledocholithiasis were randomly assigned to undergo surgical decompression of the biliary tract (41 patients) or endoscopic biliary drainage (41 patients), followed by definitive treatment. Hospital mortality was analyzed with respect to the use of endoscopic biliary drainage and other clinical and laboratory findings. Prognostic determinants were studied by linear discriminant analysis.Complications related to biliary tract decompression and subsequent definitive treatment developed in 14 patients treated with endoscopic biliary drainage and 27 treated with surgery (34 vs. 66 percent, P greater than 0.05). The time required for normalization of temperature and stabilization of blood pressure was similar in the two groups, but more patients in the surgery group required ventilatory support. The hospital mortality rate was significantly lower for the patients who underwent endoscopy (4 deaths) than for those treated surgically (13 deaths) (10 vs. 32 percent, P less than 0.03). The presence of concomitant medical problems, a low platelet count, a high serum urea nitrogen concentration, and a low serum albumin concentration before biliary decompression were the other independent determinants of mortality in both groups.Endoscopic biliary drainage is a safe and effective measure for the initial control of severe acute cholangitis due to choledocholithiasis and to reduce the mortality associated with the condition. |
| Databáze: | OpenAIRE |
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