ERCP under general anesthesia (GA): Indications and outcomes

Background: The safety and efficacy of GA for ERCP has not been studied systematically. We describe our referral center experience with the use of GA for ERCP. Methods: Patients undergoing ERCP with GA were identified in our computerized database; their medical charts and endoscopy reports were reviewed. Results: 52 patients (31 women, 21 men), median age 36 years (range 9 months - 80 years), underwent a total of 63 ERCPs under GA at our center between 6/93 and 11/96. GA was administered by an anesthesiology team in the endoscopy unit. All patients were extubated immediately after completion of ERCP. Indications for ERCP included pancreatitis (including evaluation of pseudocysts)(19), episodic or chronic abdominal pain (13), cholestasis of unclear etiology (5), treatment of documented bile duct stones (4), and "other" (9), including evaluation of hemobilia, treatment of an unresectable papillary tumor, collection of pancreatic juice, and treatment of traumatic disruption of pancreatic duct (PD) or bile duct. 13 patients were age 14 or younger. None of these pediatric patients had undergone ERCP prior to the index procedure. Of the 39 adult patients, 37 had undergone at least one prior attempt at ERCP with standard conscious sedation. Indications for GA in the 39 adult patients were failed conscious sedation (35), pulmonary disease (2), and allergy to multiple sedative drugs (1). One patient refused conscious sedation and requested GA. ERCP was considered successful in all pediatric patients and in 35/39 adult patients (including 33 patients who had previously failed ERCP). Four failures included 2 diagnostic and 2 therapeutic procedures and were due to inability to locate the papilla in a patient with Billroth II anatomy (1), failure of cannulation of the PD (1), inability to remove a surgically placed stent (1), and retained bile duct stones despite repeated attempts at removal (1). There were 4 procedure-related complications, all pancreatitis (3 mild, one severe). No GA related complications were noted. Conclusions: GA allows successful completion of diagnostic and therapeutic ERCP in children, and adults who have previously failed conscious sedation wilhout an excess of complications.

Duke Scholars

Author Malcolm Stanley Branch Medicine, Gastroenterology

Author Paul Simon Jowell Medicine, Gastroenterology