Lockdown period during SARS COVID-19 endemic outbreak in Taiwan did not cause an increase of the complications nor mortality of patients received endoscopic retrograde cholangiopancreatography - A single-center retrospective study

Sep 29, 2026

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Lockdown measures during the COVID-19 pandemic reduced elective endoscopic procedures, raising concern that endoscopic retrograde cholangiopancreatography (ERCP) might be delayed and worsen outcomes. This single-center retrospective study compared patients with obstructive jaundice and acute cholangitis from May 16 to July 26, 2021 with a similar pre-pandemic period in 2019. Findings showed longer hospital stays and higher biliary enzyme levels in 2021, while ERCP-related complications and mortality did not differ significantly.

LanguageEnglish

CategoryHealthcare

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Abstract

Background

Methods

Results

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Introduction

J Chin MedAssoc Original article Lockdown period during SARS COVID-19 endemic outbreak in Taiwan did not cause an increase of the complications nor mortality of patients received endoscopic retrograde cholangiopancreatography: A single-center retrospective study Chia-Ju Lia, Tien-En Changa,b,c, Ming-Chih Houa,c,*, Yi-Hsiang Huanga,c, Pei-Chang Leea,c, Nai-Wen Changd, Yu-Jen Chena,c, Fa-Yuah Leea,b aDivision of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; bEndoscopy Center for Diagnosis and Treatment, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; cDepartment of Medicine, Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan, ROC; dDepartment of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC Abstract Background: Coronavirus disease 2019, known as a widespread, aerosol spreading disease, has affected >549 000 000 people since 2019. During the lockdown period, dramatic reduction of elective endoscopic procedures, including endoscopic retrograde cholangiopancreatography, had been reported worldwide, leading to delayed diagnosis and treatment. Nevertheless, whether patients’ hospital stays and complication rate of endoscopic retrograde cholangiopancreatography (ERCP) during the lockdown period were influenced by the pandemic still remains controversial. Methods: Patients who diagnosed with obstructive jaundice and acute cholangitis in the lockdown period, May 16 to July 26, 2021, were compared to the same prepandemic period in 2019. Results: A total of 204 patients in 2019 and 168 patients in 2021 were diagnosed with acute biliary cholangitis or obstructive jaundice, and 82 of the patients in 2019 and 77 patients in 2021 underwent ERCP (p = 0 .274) . Patients whose quick Sequential Organ Failure Assessment (qSOFA) score was ≥ 2 occurred more during the lockdown period than during the normal period (24/77, 31. 1% vs 12/82, 14.6%; p = 0.013) . The initial laboratory data, including, total bilirubin (4 .12 in 2021 vs 3.08 mg/dL in 2019; p = 0.014), gamma-glutamyl transferase (378 in 2021 vs 261 U/L in 2019; p = 0.009), and alkaline phosphatase (254 in 2021 vs 174 U/L in 2019; p = 0 .002) were higher during the lockdown period compared to 2019. Hospital stay was statistically significant longer in the lockdown period (11 days [7 .00–22.00] in 2021 vs 8 days in 2019 [6 .00–12.00]; p value = 0 .02) . Multivariate analysis showed that qSOFA ≥ 2 (hazard ratio [HR] = 3 .837, 95% confidence interval [CI] = 1.471–10.003; p = 0.006), and malignant etiology (HR = 2.932, 95% CI = 1.271–6.765; p = 0 .012) were the statistically significant factors for a prolonged hospital stay, which was defined as hospital stay >21 days. ERCP-related complications and mortality rate were not statistically different between the two periods. Conclusion: Patients from May 16 to July 26, 2021, the lockdown period, had longer hospital stays and higher biliary tract enzyme levels, which indicated more severe disease. Nevertheless, ERCP could be safely and successfully performed even during the medical level 3 alert lockdown period without causing an increase in procedure-related complications and mortality. Keywords: Coronavirus disease 2019; Endoscopic retrograde cholangiopancreatography; Endoscopic papillotomy; Quick Sequential Organ Failure Assessment *Address correspondence. Dr. Ming-Chih Hou, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, ROC. E-mail address: mchou@ [vghtpe.gov.tw](vghtpe.gov.tw) (M.-C. Hou). Conflicts of interest: Dr. Ming-Chih Hou, Dr. Yi-Hsiang Huang, and Dr. Fa-Yuah Lee, editorial board members at Journal of the Chinese Medical Association, have no roles in the peer-review process of or decision to publish this article. The authors d

FAQs

What clinical question did the study address about lockdown and ERCP outcomes?

The study examined whether the lockdown period during the COVID-19 endemic outbreak affected hospital stay length and the complication rate of ERCP patients, since findings in prior reports were controversial.

How were patients selected for comparison between 2021 and 2019?

Patients diagnosed with obstructive jaundice and acute cholangitis during the lockdown period (May 16 to July 26, 2021) were compared with patients from the same prepandemic period in 2019.

What were the main outcome differences between the lockdown and normal periods?

During the lockdown period, patients had longer hospital stays and higher biliary tract enzyme levels, and qSOFA ≥ 2 occurred more frequently. However, ERCP-related complications and mortality rates were not significantly different between the two periods.

Sep 29, 2026

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