Technical and clinical outcomes of urgent ERCP performed with single-use duodenoscope (SUD) in consecutive patients with moderate-to-severe cholangitis – a single-center prospective study

Aims To assess the outcomes of urgent ERCP performed with single-use duodenoscope (SUD) in patients admitted for moderate or severe cholangitis. Methods Between 2021-2022 consecutive patients with moderate-to-severe cholangitis were prospectively enrolled. Procedures were conducted with EXALT-D scope (Boston Scientific). Technical success rate was defined as the completion of the planned procedure without the need to switch to a reusable duodenoscope. Patients were followed up for 3-month. Results Twenty-one consecutive patients (11 female, age 82 [67-91] years) were enrolled. Five (23.8%) had severe cholangitis; 17 (81.0%) were ASA 3 ore 4. Median age-adjusted Charlson comorbidity index was 6 [4-9]; 8 patients (38.1%) were on antiplatelet agents. Mean white blood cell count was 8300 ± 3900/mmc; median C reactive protein was 8 [5-12] mg/dL; mean procalcitonin was 4.3 ± 2.3 ng/mL. 11 patients (52.4%) had gallbladder in situ; 16 (76.2%) had a naïve papilla. Technical success rate was 100% (no need to switch). In 17 (80.9%) cases biliary sphincterotomy and in 5 (23.8%) cases large-balloon papillary were performed. In 18 (85.7%) cases, complete stone clearance was achieved; in 6 (28.6%) cases, biliary stent was placed. No patients had post-ERCP pancreatitis or infections. Two (9.5%) showed delayed bleeding (due to stent migration and EUS-GBD). All patients achieved clinical success rate and no patient died within 30-day. In-hospital and 3-month mortality were 4.8% and 14.3%, respectively. No recurrent cholangitis was observed. Conclusions SUD use for urgent ERCP was safe and effective in moderate or severe cholangitis. This approach eliminates duodenoscope contamination without impairing patients' outcomes. Publication History Article published online: 14 April 2023 © 2023. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany