# Impact of the COVID‐19 pandemic on the treatment of acute cholangitis caused by choledocholithiasis: A single‐center retrospective study in Japan

## TL;DR

This study found that the COVID-19 pandemic led to more single-stage endoscopic treatments and shorter hospital stays for acute cholangitis in Japan.

## Contribution

The study reveals how pandemic conditions altered treatment patterns for cholangitis without compromising safety.

## Key findings

- The number of ERCP cases and single-stage endoscopic stone removals increased after the pandemic emergency declaration.
- Hospital stays were significantly shorter in the post-pandemic group.
- No differences in adverse event rates were observed between pre- and post-pandemic groups.

## Abstract

This study aimed to determine the impact of the coronavirus disease 2019 (COVID‐19) pandemic on the treatment of acute cholangitis caused by choledocholithiasis.

The Japanese government declared a state of emergency in April 2020 due to the COVID‐19 pandemic. We retrospectively reviewed the medical records of 309 patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) for acute cholangitis caused by choledocholithiasis between April 2017 and December 2022.

Patients were categorized into a pregroup (n = 134) and a postgroup (n = 175), depending on whether they were diagnosed before or after the state of emergency declaration. The total number of ERCP cases and the number of ERCP cases with endoscopic stone removals increased after the state of emergency declaration. Compared with the pregroup, the numbers of patients with performance status of 0–1 and surgically altered anatomy increased, whereas the numbers of patients taking oral antiplatelets or anticoagulants and those with cerebrovascular disease decreased in the postgroup. The number of single‐stage endoscopic stone removals increased and hospital stays were significantly shorter in the postgroup. No differences in adverse event rates were detected between the two groups.

Although our hospital provides tertiary care, the number of patients with cholangitis in good general condition and no underlying disease increased after the state of emergency declaration. The COVID‐19 pandemic resulted in an increase in the number of single‐stage endoscopic treatments and shortened hospital stays for patients with acute cholangitis caused by choledocholithiasis. No safety issues with ERCP were detected, even during the pandemic.