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Surgeon-performed endoscopic retrograde cholangiopancreatography. Outcomes of 2392 procedures at two tertiary care centers

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Abstract

Background

Endoscopic retrograde cholangiopancreatography (ERCP) is a common procedure that, in the United States, is traditionally performed by gastroenterologists. We hypothesized that when performed by well-trained surgeons, ERCP can be performed safely and effectively. The objectives of the study were to assess the rate of successful cannulation of the duct of interest and to assess the 30-day complication and mortality rates.

Methods

We retrospectively reviewed the charts of 1858 patients who underwent 2392 ERCP procedures performed by five surgeons between August 2003 and June 2016 in two centers. Demographic and historical data, indications, procedure-related data and 30-day complication and mortality data were collected and analyzed.

Results

The mean age was 53.4 (range 7–102) years and 1046 (56.3%) were female. 1430 (59.8%) of ERCP procedures involved a surgical endoscopy fellow. The most common indication was suspected or established uncomplicated common bile duct stones (n = 1470, 61.5%), followed by management of an existing biliary or pancreatic stent (n = 370, 15.5%) and acute biliary pancreatitis (n = 173, 7.2%). A therapeutic intervention was performed in 1564 (65.4%), a standard sphincterotomy in 1244 (52.0%), stent placement in 705 (29.5%) and stone removal in 638 (26.7%). When cannulation was attempted, the rate of successful cannulation was 94.1%. When cannulation was attempted during the patient’s first ERCP the cannulation rate was 92.4%. 94 complications occurred (5.4%); the most common complication was post-ERCP pancreatitis in 75 (4.2%), significant gastrointestinal bleeding in 7 (0.4%), ascending cholangitis in 11 (0.6%) and perforation in 1 (0.05%). 11 mortalities occurred (0.5%) but none of which were ERCP-related.

Conclusion

When performed by well-trained surgical endoscopists, ERCP is associated with high success rate and acceptable complication rates consistent with previously published reports and in line with societal guidelines.

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Acknowledgements

The authors thank Nathan LaFayette, Teresa Jones, Morgan White, Lauren Hughes, and Breana Lovell for their help in data collection.

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Authors and Affiliations

  1. Department of Surgery, The Ohio State University/Wexner Medical Center, N729 Doan Hall, 410 West 10th Avenue, Columbus, OH, 43210, USA

    Mazen R. Al-Mansour, Eleanor C. Fung, Nichole E. Zayan, Timothy D. Wetzel, Sara E. Martin del Campo, Anahita D. Jalilvand, Andrew J. Suzo, Rebecca R. Dettorre, Michael P. Meara, Vimal K. Narula & Jeffrey W. Hazey

  2. Department of Surgery, Denver Veterans Affairs Medical Center, University of Colorado, Denver, CO, USA

    Edward L. Jones

  3. Department of General Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA

    James K. Fullerton & John D. Mellinger

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  1. Mazen R. Al-Mansour
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  2. Eleanor C. Fung
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  9. Rebecca R. Dettorre
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  11. Michael P. Meara
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  12. John D. Mellinger
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  13. Vimal K. Narula
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  14. Jeffrey W. Hazey
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Corresponding author

Correspondence to Jeffrey W. Hazey.

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Disclosures

Mazen R. Al-Mansour, Eleanor C. Fung, Edward L. Jones, Nichole E. Zayan, Timothy D. Wetzel, Sara E. Martin del Campo, Anahita D. Jalilvand, Andrew J. Suzo, Rebecca R. Dettorre, James K. Fullerton, Michael P. Meara, John D. Mellinger, Vimal K. Narula, and Jeffrey W. Hazey have no conflicts of interest or financial ties to disclose.

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Al-Mansour, M.R., Fung, E.C., Jones, E.L. et al. Surgeon-performed endoscopic retrograde cholangiopancreatography. Outcomes of 2392 procedures at two tertiary care centers. Surg Endosc 32, 2871–2876 (2018). https://doi.org/10.1007/s00464-017-5995-x

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