Clinical

Age and smoking predict emergency biliary drainage in acute cholangitis

Last Updated: 2006-08-22 12:32:06 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Conservative management of acute cholangitis has a high failure rate in older and higher risk patients, which include chronic smokers. Therefore, acute biliary decompression should be considered early in the course of treatment in this group, Chinese physicians report.

Drs. Yeung Yuk Pang and Yip Andrew Wai Chun of Kwong Wah Hospital in Hong Kong conducted a retrospective analysis of 171 consecutive patients admitted to their institution with acute cholangitis. Conservative treatment with intravenous antibiotics and fluids was instituted, followed by emergency biliary drainage if that failed.

Drs. Pang and Chun analyzed the cases to determine predictors of emergency biliary drainage.

Patients older than 75 and chronic smokers were the least likely to respond to conservative therapy, the Hong Kong team reports in the July issue of the European Journal of Gastroenterology and Hepatology.

Other risk factors for emergency surgery were prolonged prothrombin time, high blood glucose and dilated common bile duct diameter on ultrasound.

Drs. Pang and Wah caution that "it is definitely not our suggestion that a surgical approach is the first choice for urgent biliary drainage," but older age and chronic smoking "correlated with the need for urgent intervention."

Further study is needed to determine the validity of these findings, Dr. Pang and Wah emphasize.

Eur J Gastroenterol Hepatol 2006;18:727-731.