Early Endoscopic Retrograde Cholangiopancreatography for Managing Central Bile Duct Injury in Traumatic Liver Rupture: A Retrospective Cohort Study.

BACKGROUND: Traumatic liver rupture with central bile duct injury (CBDI) presents a complex clinical challenge associated with high morbidity. The role and optimal timing of endoscopic retrograde cholangiopancreatography (ERCP) in this setting remain controversial. This study aimed to compare the clinical outcomes of early versus delayed/on-demand ERCP in managing such injuries. MATERIALS AND METHODS: This retrospective cohort study (2020-2024) included 120 trauma patients with liver rupture and confirmed CBDI at The Second People's Hospital of Changzhou Trauma Center. Patients were divided into early ERCP (≤ 72 h, n = 62) and delayed/on-demand ERCP (> 72 h or for complications, n = 58). Primary outcome was abdominal infection incidence; secondary outcomes included biloma, enteral nutrition (EN) establishment, length of hospital stay (LOS), and unplanned re-interventions. RESULTS: Compared to the delayed/on-demand group, the early ERCP group had significantly lower rates of abdominal infection (19.4% vs. 36.2%, P = 0.04) and biloma formation (8.1% vs. 22.4%, P = 0.03). They also achieved earlier EN initiation (median 3.0 vs. 6.0 days, P < 0.001) and target (median 7.0 vs. 12.0 days, P < 0.001), and had shorter LOS (24.2 ± 8.5 days vs. 32.5 ± 11.0 days, P < 0.001). No significant difference in post-ERCP pancreatitis was observed (P = 0.68). Multivariate analysis identified delayed ERCP (OR 2.58, 95%CI 1.30-5.12) and concomitant bowel injury (OR 3.05, 95%CI 1.42-6.55) as independent risk factors for abdominal infection. CONCLUSIONS: Early ERCP (≤ 72 h) is an effective management strategy for traumatic liver rupture with CBDI. It significantly reduces infectious complications, facilitates early EN, and shortens hospital stay, representing an optimized multidisciplinary approach for these complex patients.