Advertisement

Surgical Endoscopy

, Volume 24, Issue 7, pp 1701–1706 | Cite as

Is outpatient ERCP suitable, feasible, and safe? The experience of a Spanish community hospital

  • Luís RábagoEmail author
  • Ivan Guerra
  • Marta Moran
  • Elvira Quintanilla
  • David Collado
  • Inmaculada Chico
  • Ana Olivares
  • Jose Luis Castro
  • Francisco Gea
Article

Abstract

Background

We wanted to evaluate the safety of outpatient endoscopic retrograde cholangiopancreatography (ERCP). The follow-up of an ERCP outpatient during a short observation period could be a feasible and safe approach.

Methods

To evaluate the safety of outpatient ERCP, we assessed the rate of post-ERCP complications found and missed during a 6-h observation period after therapeutic ERCP.

Results

We performed 236 ERCPs on an outpatient basis, with a failure rate of 3.7% but with an overall completion rate for the intended treatment of 90.7%. Seventy-eight percent of the ERCPs were primarily therapeutic. The age of the patients was 63.9 years and 61.9% were females. One hundred seventy-seven (74.5%) patients were discharged from the hospital after the observation period. Thirty-three (14.1%) patients were admitted without further delay due to unexpected ERCP findings or for early detection of complications. Twenty-seven (11.4%) patients had a prolonged hospital stay because of complications during the observation period. Just two patients previously discharged developed later complications: cholangitis and pancreatitis (0.84% of the ERCPs and 7.4% of the overall complications). There were 27 ERCP complications (12.1%). Of the overall complications, 29.6% were diagnosed very early after the procedure and 62.9% were diagnosed during the observation period. 8.9% out of the 12.1% of the ERCP complications were mild to moderate. There was no mortality.

Conclusion

Twenty-five (92.6%) of ERCP complications occurred during the first 6 h, making the use of this short observation period safe for an early discharge. The evolution of the patients who developed delayed complications was unremarkable. Whenever outpatient ERCP is feasible, it should be done to help cut costs.

Keywords

ERCP (Endoscopic retrograde cholangiopancreatography) Biliopancreatic therapeutic procedures CBD (Common bile duct) Complications 

Notes

Disclosure

Luís Rábago, Ivan Guerra, Marta Moran, Elvira Quintanilla, David Collado, Inmaculada Chico, Ana Olivares, Jose Luis Castro, and Francisco Gea have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Cotton PB, Lehman G, Vennes J, Geenen JE, Russell RC, Meyers WC, Liguory C, Nickl N (1991) Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc 37(3):383–393CrossRefPubMedGoogle Scholar
  2. 2.
    Freeman ML, Nelson DB, Sherman S, Haber GB, Herman ME, Dorsher PJ, Moore JP, Fennerty MB, Ryan ME, Shaw MJ, Lande JD, Pheley AM (1996) Complications of endoscopic biliary sphincterotomy. N Engl J Med 335(13):909–918CrossRefPubMedGoogle Scholar
  3. 3.
    Mallery JS, Baron TH, Dominitz JA, Goldstein JL, Hirota WK, Jacobson BC, Leighton JA, Raddawi HM, Varg JJ 2nd, Waring JP, Fanelli RD, Wheeler-Harbough J, Eisen GM, Faigel DO, Standards of Practice Committee of American Society for Gastrointestinal Endoscopy (2003) Complications of ERCP. Gastrointest Endosc 57(6):633–638CrossRefPubMedGoogle Scholar
  4. 4.
    Johanson JF, Cooper G, Eisen GM, Freeman M, Goldstein JL, Jensen DM, Sahai A, Schmitt CM, Schoenfeld P, American Society of Gastrointestinal Endoscopy Outcomes Research Committee (2002) Quality assessment of ERCP. Endoscopic retrograde cholangiopancreatography. Gastrointest Endosc 56(2):165–169CrossRefPubMedGoogle Scholar
  5. 5.
    Freeman ML, DiSario JA, Nelson DB, Fennerty MB, Lee JG, Bjorkman DJ, Overby CS, Aas J, Ryan ME, Bochna GS, Shaw MJ, Snady HW, Erickson RV, Moore JP, Roel JP (2001) Risk factors for post-ERCP pancreatitis: a prospective, multicenter study. Gastrointest Endosc 54(4):425–434CrossRefPubMedGoogle Scholar
  6. 6.
    Freeman ML, Nelson DB, Sherman S, Haber GB, Fennerty MB, DiSario JA, Ryan ME, Kortan PP, Dorsher PJ, Shaw MJ, Herman ME, Cunningham JT, Moore JP, Silverman WB, Imperial JC, Mackie RD, Jamidar PA, Yakshe PN, Logan GM, Pheley AM (1999) Same-day discharge after endoscopic biliary sphincterotomy: observations from a prospective multicenter complication study. The Multicenter Endoscopic Sphincterotomy (MESH) Study Group. Gastrointest Endosc 49(5):580–586CrossRefPubMedGoogle Scholar
  7. 7.
    Jeurnink SM, Poley JW, Steyerberg EW, Kuipers EJ, Siersema PD (2008) ERCP as an outpatient treatment: a review. Gastrointest Endosc 68(1):118–123CrossRefPubMedGoogle Scholar
  8. 8.
    Elfant AB, Bourke MJ, Alhalel R, Kortan PP, Haber GB (1996) A prospective study of the safety of endoscopic therapy for choledocholithiasis in an outpatient population. Am J Gastroenterol 91(8):1499–1502PubMedGoogle Scholar
  9. 9.
    Mehta SN, Pavone E, Barkun AN (1996) Outpatient therapeutic ERCP: a series of 262 consecutive cases. Gastrointest Endosc 44(4):443–449CrossRefPubMedGoogle Scholar
  10. 10.
    Podolsky I, Kortan P, Haber GB (1989) Endoscopic sphincterotomy in outpatients. Gastrointest Endosc 35(5):372–376CrossRefPubMedGoogle Scholar
  11. 11.
    Cvetkovski B, Gerdes H, Kurtz RC (1999) Outpatient therapeutic ERCP with endobiliary stent placement for malignant common bile duct obstruction. Gastrointest Endosc 50(1):63–66CrossRefPubMedGoogle Scholar
  12. 12.
    Guitron-Cantu A, Adalid-Martinez R, Gutierrez-Bermudez JA (2003) Endoscopic sphincterotomy as an out-patient procedure: is it safe? Rev Gastroenterol Mex 68(3):178–184PubMedGoogle Scholar
  13. 13.
    Fox CJ, Harry RA, Cairns SR (2000) A prospective series of out-patient endoscopic retrograde cholangiopancreatography. Eur J Gastroenterol Hepatol 12(5):523–527CrossRefPubMedGoogle Scholar
  14. 14.
    Tham TC, Vandervoort J, Wong RC, Lichtenstein DR, Van Dam J, Ruymann F, Farraye F, Carr-Locke DL (1997) Therapeutic ERCP in outpatients. Gastrointest Endosc 45(3):225–230CrossRefPubMedGoogle Scholar
  15. 15.
    Hui CK, Lai KC, Wong WM, Yuen MF, Ng M, Chan CK, Hu W, Cheung WW, Lai CL, Wong BC (2004) Outpatients undergoing therapeutic endoscopic retrograde cholangiopancreatography: six-hour versus overnight observation. J Gastroenterol Hepatol 19(10):1163–1168CrossRefPubMedGoogle Scholar
  16. 16.
    Duncan HD, Hodgkinson L, Deakin M, Green JR (1997) The safety of diagnostic and therapeutic ERCP as a daycase procedure with a selective admission policy. Eur J Gastroenterol Hepatol 9(9):905–908PubMedGoogle Scholar
  17. 17.
    Ho KY, Montes H, Sossenheimer MJ, Tham TC, Ruymann F, Van Dam J, Carr-Locke DL (1999) Features that may predict hospital admission following outpatient therapeutic ERCP. Gastrointest Endosc 49(5):587–592CrossRefPubMedGoogle Scholar
  18. 18.
    Owens WD, Felts JA, Spitznagel EL Jr (1978) ASA physical status classifications: a study of consistency of ratings. Anesthesiology 49(4):239–243CrossRefPubMedGoogle Scholar
  19. 19.
    Bjorkman DJ, Van Dam J (1996) Outpatient therapeutic ERCP: cutting sphincters and cutting costs. Am J Gastroenterol 91(8):1485–1486PubMedGoogle Scholar
  20. 20.
    Sherman S, Hawes RH, Nisi R, Lehman GA (1992) Endoscopic sphincterotomy-induced hemorrhage: treatment with multipolar electrocoagulation. Gastrointest Endosc 38(2):123–126CrossRefPubMedGoogle Scholar
  21. 21.
    Baillie J, Testoni PA (2007) Are we meeting the standards set for ERCP? Gut 56(6):744–746CrossRefPubMedGoogle Scholar
  22. 22.
    Loperfido S, Angelini G, Benedetti G, Chilovi F, Costan F, De Berardinis F, De Bernardin M, Ederle A, Fina P, Fratton A (1998) Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study. Gastrointest Endosc 48(1):1–10CrossRefPubMedGoogle Scholar
  23. 23.
    Vandervoort J, Soetikno RM, Tham TC, Wong RC, Ferrari AP Jr, Montes H, Roston AD, Slivka A, Lichtenstein DR, Ruymann FW, Van Dam J, Hughes M, Carr-Locke DL (2002) Risk factors for complications after performance of ERCP. Gastrointest Endosc 56(5):652–656CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Luís Rábago
    • 1
    • 2
    Email author
  • Ivan Guerra
    • 1
  • Marta Moran
    • 1
  • Elvira Quintanilla
    • 1
  • David Collado
    • 1
  • Inmaculada Chico
    • 1
  • Ana Olivares
    • 1
  • Jose Luis Castro
    • 1
  • Francisco Gea
    • 1
  1. 1.Department of GastroenterologyHospital Severo Ochoa (Leganés)MadridSpain
  2. 2.MadridSpain

Personalised recommendations