Abstract
BACKGROUND: Severe acute cholangitis is a potentially life-threatening disease in low-middle income countries (LMIC). Due to limited endoscopic services, these patients mostly undergo percutaneous transhepatic biliary drainage (PTBD). Studies from developed countries reported more complications with PTBD as compared with endoscopic retrograde cholangiopancreatography (ERCP). AIM: To compare safety, therapeutic success, and survival among the PTBD and ERCP procedure in severe cholangitis in LMIC. METHODS: A retrospective study was conducted in the Aga Khan University Hospital from January 2017 to December 2023. All patients who had severe acute cholangitis and underwent ERCP or PTBD were included. Patients were followed for complications, procedure success, and mortality. Data was gathered through an electronic medical record system and analyzed using χ² and two sample t-tests. RESULTS: A total of 33 patients were recruited, consisting of 12 females and 21 males with a mean age of 61 years. Among these participants, 12 patients underwent ERCP, and the remaining 21 patients underwent PTBD. Therapeutic success was seen more in the ERCP group [11/12 (97.1%)] than in the PTBD group [12/21 patients (57.1%)]. Post-procedure complications were seen in both groups; however, more were observed in the PTBD cohort with a significant P value of 0.02. There were no mortalities among the patients who underwent ERCP while 5 (23.8%) mortalities were seen in the PTBD group. CONCLUSION: Fewer post-procedure complications and deaths were observed after ERCP than after PTBD, laying the foundation for large prospective studies and shifting the local paradigm of acute cholangitis treatment in LMICs.