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Abstract Introduction: Acute obstructive suppurative cholangitis (AOSC) is a life-threatening biliary tract infection requiring urgent intervention. With the advancement of endoscopic techniques, endoscopic retrograde cholangiopancreatography (ERCP) has become a preferred alternative to traditional surgery. This study aimed to compare the clinical efficacy and safety of ERCP with laparoscopic common bile duct exploration (LCBDE) in patients with AOSC. Patients and Methods: This retrospective study included 174 patients diagnosed with AOSC at Shangrao Municipal Hospital between December 2021 and December 2024. Participants were retrospectively assigned to two exposure groups based on treatment received: ERCP group ( n = 70) and LCBDE group ( n = 104). No matching was performed. Clinical outcomes, including intraoperative parameters, post-operative recovery, complications and treatment efficacy within 30 days, were analysed. Logistic regression was used to identify independent predictors of treatment success. Results: Compared to the laparoscopic group, the ERCP group showed markedly reduced intraoperative blood loss and shorter operation time ( P < 0.001). On post-operative day 7, the ERCP group had lower white blood cell (WBC) counts and serum aspartate aminotransferase levels ( P < 0.05). The overall complication rate (17.14% vs. 35.58%, P = 0.008) was lower, and the treatment efficacy rate (85.71% vs. 66.35%, P = 0.004) was higher in the ERCP group. Multivariate analysis identified ERCP, higher pre-operative alanine aminotransferase and lower post-operative WBC as independent predictors of successful treatment. Conclusion: ERCP is a safe and effective minimally invasive treatment for AOSC, offering advantages in recovery and complication reduction. It is especially suitable for elderly and high-risk patients.
Liu et al. (Mon,) studied this question.