Diagnostic and Therapeutic Value of Endoscopic Retrograde Cholangiopancreatography in Acute Cholangitis: A Study From Kashmir Valley, India

Background Cholangitis, or bile duct infection, can present in two primary forms, namely, acute ascending cholangitis (the milder form) and acute fulminant cholangitis (the more severe variety). In all types of cholangitis, bile duct obstruction occurs, with choledocholithiasis (the presence of gallstones in the bile duct) being the leading cause of this blockage. <i>Escherichia coli</i> is the most commonly isolated pathogen in these infections. If the biliary duct infection becomes suppurative, sepsis is a common complication. Cholangitis can lead to significant morbidity and mortality, which may persist even with prompt treatment or drainage. Endoscopic retrograde cholangiopancreatography (ERCP) remains a crucial diagnostic and therapeutic tool for managing acute cholangitis. Despite its importance in managing cholangitis, there is limited research on the characteristics and outcomes of ERCP in patients with acute cholangitis from Kashmir in northern India. This study was conducted to explore the role and effectiveness of ERCP in the diagnosis and treatment of acute cholangitis. Methodology This observational study was conducted in the Department of Gastroenterology at a tertiary care hospital in North India over a period of two years, from January 1, 2018, to December 31, 2019. The study included 48 consecutive patients diagnosed with acute cholangitis who underwent ERCP for both diagnostic and therapeutic purposes. Results The median age of the patients included in the study was 55 years and the male-to-female ratio in the study cohort was 1.6:1, with 30 (62.5%) males and 18 (37.5%) females. Among the patients with comorbid conditions, hypertension was the most common, present in 12.5% of cases. Choledocholithiasis was the most frequent diagnosis, identified in 70.83% of patients. Ultrasonography of the abdomen revealed choledocholithiasis in 34 (70.83%) cases, the most common radiological finding. A comparison of clinical symptoms and diagnostic test results before and after 72 hours of ERCP demonstrated a statistically significant improvement in patient outcomes following the procedure. Conclusions In contrast to other diagnostic approaches for evaluating biliary duct obstruction, timely ERCP remains a reliable and effective option for both diagnosis and therapeutic intervention in acute cholangitis. It is associated with improved diagnostic accuracy, enhanced therapeutic outcomes, and reduced morbidity and mortality rates, making it a critical tool in managing this potentially life-threatening condition.