Treatment of acute cholangitis of severe type with different modes of biliary drainage under X-ray-free endoscopy: a single center, retrospective study

To compare the efficacy of X-ray-free endoscopic internal biliary drainage with external biliary drainage for treatment of acute cholangitis of severe type (ACST). Sixty elderly patients with ACST were retrospectively analyzed. Patients were divided into an internal group, who underwent endoscopic retrograde biliary drainage (ERBD) with a plastic stent and an external group, who received nasobiliary drainage. Improvements in symptoms including abdominal pain, fever, and shock and changes in liver function, white blood cell counts, procalcitonin, blood urea nitrogen and Systemic Inflammatory Response Syndrome scores before and after the operation were analyzed. Complications and operation times were compared. After the operation, the symptoms were significantly improved and each biochemical index was significantly decreased in the two groups, with statistically significant differences observed compared to the pre-operation conditions. In the internal and external drainage groups after the operation, the symptoms were significantly alleviated in 86.7% (26/30) and 90.0% (27/30) of cases, respectively and there were no significant differences in biochemical indexes between the two groups. However, the operation time was significantly shorter in the internal drainage group (P = 0.001 vs. external drainage group) and no endoscopyrelated severe complications occurred in either group. Both the internal and external drainage methods relieve biliary obstruction, and quickly alleviate the symptoms. Both methods are suitable for critically ill patients who are not transportable; however, the internal drainage method is characterized by practical simplicity, short duration and high success rate of first-time indwelling, which is more acceptable to patients.