To evaluate the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) plus biliary drainage combined with gallbladder drainage for acute cholecystitis complicated with cholangitis and to construct an efficacy prediction model.

Clinical data of 77 patients with acute cholecystitis complicated with cholangitis who received ERCP in Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from September 2022 to April 2024 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 44 patients were male and 33 female, aged from 61 to 86 years, with a median age of 70 years. According to the success of ERCP gallbladder drainage, all patients were divided into the success and failure groups. In the success group, ERCP plus choledocholithotomy/biliary drainage+gallbladder drainage were adopted. In the failure group, choledocholithotomy/biliary drainage combined with percutaneous gallbladder puncture and drainage or cholecystectomy were performed in some patients. The success rate, clinical remission rate and postoperative adverse events in two groups were observed and recorded. The independent risk factors of failed gallbladder drainage were determined by multivariate Logistic regression analysis in some patients. The predictive value of regression model for successful gallbladder drainage was assessed by the receiver operating characteristic (ROC) curve.

The clinical remission rate was 99%(76/77). Due to limited emergency operation conditions, the success rate of ERCP plus gallbladder drainage was 42%(32/77). The failure rate of gallbladder drainage was 58%(45/77). Among them, the symptoms of 12 cases were controlled by gallbladder puncture or emergency surgery, and 1 died of multiple organ failure. The remaining patients achieved clinical remission. No significant differences were found in the incidence and recurrence rate of adverse events between two groups (both P>0.05). Postoperatively, 5 patients developed hyperamylasemia, which were alleviated without special treatment. No bleeding or perforation occurred. In the success group, 1 patient experienced mild pancreatitis after surgery, which was mitigated after conservative medical treatment. 1 case developed postoperative pulmonary infection, which was improved after anti-infection treatment. At 6 months after ERCP, 6 cases had recurrent infection of the biliary system, including 5 in the failure group and 1 in the success group.Multivariate Logistic regression analysis showed that post-gastric bypass (OR=31.775, 95%CI: 1.711-590.155), the total operation time (OR=0.888, 95%CI: 0.820-0.961), direct vision under choledochoscope (OR=0.066,95%CI: 0.005-0.795) were the independent risk factors of failed gallbladder drainage (all P<0.05). According to multivariate Logistic regression analysis, the independent influencing factors were identified, and a regression model was constructed. The model formula was ln[p/(1-p)]=3.938+3.459×post-gastric bypass -0.119×total operation time -2.719×direct vision under choledochoscope. ROC curve analysis showed that the regression model had certain predictive value. The area under the ROC curve (AUC) was 0.804, the sensitivity was 0.911 and the specificity was 0.625, respectively.

Compared with conventional ERCP plus biliary drainage combined with gallbladder puncture or surgery, ERCP plus biliary drainage combined with gallbladder drainage is an effective treatment of cholecystitis complicated with cholangitis, which is simple and minimally invasive, and does not increase the incidence of postoperative adverse events. The logistic regression model yields certain predictive value for clinical efficacy.