ERCP Performed Out‐of‐Working Hours Is Effective and Reliable for the Treatment of Acute Cholangitis

Background Acute cholangitis is a life‐threatening condition that requires prompt biliary drainage, typically achieved through endoscopic retrograde cholangiopancreatography (ERCP). However, data on outcomes of procedures performed outside of regular working hours remain limited. This study evaluates the safety and efficacy of out‐of‐working‐hours ERCP for acute cholangitis. Methods A retrospective analysis of 83 patients who underwent out‐of‐working‐hours ERCP for acute cholangitis was conducted. Patients were categorized by cholangitis severity (mild, moderate, and severe) and procedure timing (< 12, 12–24, and 24–48 h). Outcomes assessed included procedural success, complications, and clinical results. Multivariate logistic regression was used to identify predictors of prolonged hospitalization. Results Of the patients, 14.5% had mild, 19.3% moderate, and 66.3% severe cholangitis. Median time to procedure was shorter in severe cases (6.0 h) than in mild (13.5) and moderate (14.5) cases ( p = 0.016). Technical success was 100%, with 91.6% receiving stents or nasobiliary drains. Complications occurred in 6%, and mortality (3.6%) was limited to severe cases. Early intervention (< 12 h) significantly reduced prolonged hospital stays (> 15 days, p = 0.006). Conclusion Out‐of‐working‐hours ERCP was associated with high technical success and a low complication rate in this cohort. Out‐of‐working‐hours ERCP achieved high rates of successful biliary drainage with an acceptable safety profile, and ERCP performed within 12 h was independently associated with a lower risk of prolonged hospitalization.