ERCP Between 24 and 72 Hours Linked to Fewer Complications

Performing endoscopic retrograde cholangiopancreatography between 24 and 72 hours following hospital admission is associated with a significantly reduced rate of procedure-related complications compared with earlier or delayed interventions, according to findings from a retrospective observational study published in BMC Gastroenterology.

The clinical investigation evaluated whether the specific timing of endoscopic retrograde cholangiopancreatography, commonly known as ERCP, impacts procedural complication rates and the length of hospital stay across a broad patient population. Optimal procedural timing has remained a subject of ongoing controversy in clinical practice, particularly outside the management of acute cholangitis. Although existing clinical guidelines recommend early intervention for certain presentations, high-quality evidence defining specific therapeutic timeframes has remained limited.

To address this question, researchers analyzed clinical records from 406 patients who underwent ERCP between January 2021 and December 2023. The study cohort was divided into three defined groups based on the elapsed time between hospital admission and the endoscopic procedure: fewer than 24 hours, between 24 and 72 hours, and greater than 72 hours. Among the 406 participants, 102 patients (25 percent) received ERCP within 24 hours of admission, 137 patients (33.6 percent) underwent the intervention between 24 and 72 hours, and 167 patients (41.4 percent) underwent the procedure after 72 hours.

The clinical indications leading to ERCP differed substantially across the three timing intervals. Acute cholangitis was identified more frequently among patients undergoing urgent procedures within 24 hours of hospital admission. In contrast, acute pancreatitis was more commonly the procedural indication among patients experiencing delayed interventions, and malignant stricture was observed more frequently among those undergoing ERCP after 72 hours. Additionally, laboratory assessments revealed that total bilirubin levels were significantly higher among patients treated in the delayed group beyond 72 hours.

Analysis of post-procedural outcomes revealed marked differences in adverse events, including post-ERCP pancreatitis, among the cohorts. The overall rate of procedure-related complications was lowest among patients treated within the 24- to 72-hour window at 4.4 percent, compared with 12 percent in the group treated under 24 hours and 12 percent in the group treated after 72 hours (p = 0.038). In multivariate logistic regression analysis, the timing of ERCP was identified as the sole independent predictor of complications, with both urgent procedures performed under 24 hours and delayed procedures performed after 72 hours associated with a significantly higher complication risk relative to the 24- to 72-hour timeframe.

Procedural timing was also significantly associated with total hospitalization duration, with the length of hospital stay measuring shortest in the under-24-hour cohort and longest in the group treated after 72 hours (p < 0.001). The investigators concluded that conducting ERCP between 24 and 72 hours after admission achieves lower complication rates and shorter hospital stays, suggesting this timeframe may provide an optimal balance between procedural safety and clinical efficacy. The research team noted that these observational observations could help guide future prospective studies and inform procedural timing recommendations across diverse patient populations.

Methodologically, the evaluation examined demographic characteristics alongside laboratory parameters to assess how baseline patient profiles differed across the three admission intervals. While patients requiring intervention within 24 hours experienced the shortest overall hospitalization, this group faced complication rates identical to those delayed beyond 72 hours. By contrast, the intermediate window between 24 and 72 hours demonstrated that delaying the procedure past the initial 24 hours did not prolong hospitalization to the extent seen in patients waiting beyond three days, while providing a substantially lower risk of adverse procedural outcomes.

These distinctions are particularly relevant given that existing clinical guidelines advocate early endoscopic intervention, yet robust evidence establishing firm procedural timeframes has remained scarce outside of acute cholangitis. Because these findings are derived from a retrospective observational cohort of 406 patients treated between January 2021 and December 2023, the observed differences establish statistical associations rather than a proven causal mechanism. The investigators noted that prospective clinical investigations will be necessary to validate whether adhering to an intermediate 24- to 72-hour window consistently balances procedural safety and efficacy across diverse patient populations.

Subject of Research: Association of ERCP timing after hospital admission with procedure-related complications and hospital stay

Article Title: Timing of endoscopic retrograde cholangiopancreatography and its association with procedure-related complications: a retrospective observational study

Article References: Durak, I., Düzenli, T., Kaya, M., Sadecolak, M., Özden, M., & Köseoğlu, H. (2026). Timing of endoscopic retrograde cholangiopancreatography and its association with procedure-related complications: a retrospective observational study. BMC Gastroenterology. https://doi.org/10.1186/s12876-026-05521-x

Image Credits: AI Generated

DOI: 10.1186/s12876-026-05521-x

Keywords: endoscopic retrograde cholangiopancreatography, ERCP timing, post-ERCP complications, post-ERCP pancreatitis, acute cholangitis, malignant stricture, acute pancreatitis, total bilirubin, hospital admission, length of hospital stay, multivariate logistic regression, retrospective observational study, procedural complications, urgent intervention, delayed intervention, procedural indications, BMC Gastroenterology, biliary intervention