Indications for and results of urgent ERCP

Background: Cholangitis, severe gallstone pancreatitis, and bile duct injuries are indications for urgent endoscopic retrograde cholangio-pancreatography (ERCP). Performing ERCP "out of hours" has its problems as support personnel may not be available and procedure costs are increased. The outcomes associated with urgent ERCP have not been well defined. We examined indications for and outcomes of urgent ERCP performed at our tertiary care center. Methods: Urgent ERCPs performed out of routine endoscopy hours (8AM to 5PM, Monday to Friday) were identified from a computerized database. Medical charts and endoscopy records were reviewed. Results: Between 6/93 and 11/96, 2945 ERCPs were performed at our institution. Of these, 77 (2.6%) were characterized as urgent procedures. Indications included cholangitis (39/77;50.6%), obstructive jaundice without overt cholangitis (9/77; 11.7%), suspected bile duct injury (17/77; 20.7%), pancreatitis (9/77; 11.7%), hemorrhage after ERCP/sphincterotomy (1/77; 1.3%), and pain with abnormalities of liver function tests or imaging studies (2/77; 2.6%). ERCP was successful in 73/77 patients (94.8%). Failures were associated with duodenal stenosis (2) and post-operative anatomy (2). In patients with successful ERCP, a diagnosis was made in 71/73 cases. Therapeutic procedures were performed in 59/77 patients (76.6%). There was one death (1.3%); a patient with pancreatic cancer presented in shock from cholangitis due to biliary stent occlusion. Progressive hypotension during ERCP could not be reversed. Conclusions: Despite the logistical problems involved, urgent ERCP is safe and highly effective in a tertiary care setting for selected indications.

Duke Scholars

Author Paul Simon Jowell Medicine, Gastroenterology

Author Malcolm Stanley Branch Medicine, Gastroenterology