Comparison of endoscopic retrograde cholangiopancreatography drainage vs percutaneous transhepatic biliary drainage in severe cholangitis: A study from low-middle income country

doi:10.4292/wjgpt.v16.i3.107167

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World Journal of Gastrointestinal Pharmacology and Therapeutics

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2150-5349

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastrointest Pharmacol Ther. Sep 5, 2025; 16(3): 107167
Published online Sep 5, 2025. doi: 10.4292/wjgpt.v16.i3.107167

Comparison of endoscopic retrograde cholangiopancreatography drainage vs percutaneous transhepatic biliary drainage in severe cholangitis: A study from low-middle income country

Masood Muhammad Karim, Sehar Moatter, Mashal Amin, Om Parkash

Masood Muhammad Karim, Om Parkash, Section of Gastroenterology, Department of Medicine, Aga Khan University, Karachi 74800, Sindh, Pakistan

Sehar Moatter, Department of Gastroenterology, Aga Khan University Hospital, Karachi 74800, Sindh, Pakistan

Mashal Amin, Department of Community Medicine, Aga Khan University Hospital, Karachi 74800, Sindh, Pakistan

Co-corresponding authors: Masood Muhammad Karim and Om Parkash.

Author contributions: Karim MM and Moatter S wrote the manuscript; Amin M and Parkash O contributed to the data analysis; Karim MM and Parkash O contributed important and indispensable knowledge for the manuscript preparation as the co-corresponding authors; All authors read and approved the final manuscript.

Institutional review board statement: Institutional review board approval obtained. Number 2023-8486-24495.

Informed consent statement: Institutional review board exemption from informed consent.

Conflict-of-interest statement: No conflicts of interest.

Data sharing statement: No confidential details of the participants were shared.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Om Parkash, Associate Professor, Section of Gastroenterology, Department of Medicine, Aga Khan University Hospital, Stadium Road, Karachi 74800, Sindh, Pakistan. om.parkash@aku.edu

Received: March 26, 2025
Revised: May 7, 2025
Accepted: August 1, 2025
Published online: September 5, 2025
Processing time: 162 Days and 9.4 Hours

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.

Keywords: Endoscopy; Gallstones; Biliary drainage; Percutaneous transhepatic biliary drainage; Endoscopic retrograde cholangiopancreatography; Therapeutic biliary drainage; Biliary obstruction

Core Tip: Severe acute cholangitis is life-threatening, especially in low-middle income countries where percutaneous transhepatic biliary drainage (PTBD) is common due to limited endoscopic services. A retrospective study at Aga Khan University Hospital (2017-2023) found endoscopic retrograde cholangiopancreatography (ERCP) had higher therapeutic success (97.1%) compared with PTBD (57.1%) with PTBD having more complications (P = 0.02) and higher mortality (23.8%) compared with ERCP (0%). The study concluded that ERCP showed better outcomes, suggesting a shift towards ERCP in LMICs for severe cholangitis treatment.