Do Longer ERCP Procedures Lead to Higher Adverse Events?

Abstract

Purpose: The literature on the relationship between the length of ERCP procedures and adverse events is limited. Prolonged ERCP procedures might potentially lead to higher adverse events. Aims of this study were to determine the effect of length of procedures on ERCP outcomes and adverse events. Methods: All ERCPs performed in patients without prior papillary intervention from 2006-2008 by senior advanced endoscopists were reviewed. Patient demographics, procedure start time, procedure completion time, procedure characteristics, complexity scores, and adverse events were reviewed. Procedures were arbitrarily divided into two groups, Shorter Procedures (SP) whose length of procedure was lower than overall mean procedure time and Longer Procedures (LP) whose length of procedure was greater than overall mean procedure time. Length of procedure was defined as time from endoscope insertion to endoscope removal out of the patient. Adverse events included pancreatitis, bleeding, cholangitis, perforation and death. Student's t-tests and Pearson's chi-square tests were used to compare the groups. Results: A total of 295 procedures were included in the analysis. Overall mean procedure time was 45.6 ± 30.1 min (range 5-200 min). 177 procedures (60%) were SP and 118 (40%) were LP. There were no significant differences between the groups in regards to age, gender, race, or trainee participation. SP were more likely to be biliary vs. pancreatic or bi-ductal evaluations (P= 0.03). LP had significantly higher complexity scores (34% with >3 vs. 13%; P= 0.046) and were more likely to require pre-cut papillotomy (39% vs. 15%; P <0.001). There was no significant difference between the groups in overall completion rates (91.5% LP vs 96% SP; P= 0.10) or adverse events (10.2% LP vs. 6.2% SP; P= 0.21). However, LP were associated with higher rates of post-ERCP bleeding (4.2% vs. 0.6%; P= 0.029). Conclusion: Longer ERCP procedures were associated with higher procedure complexity, higher utilization of pre-cut techniques, and increased risk of post-ERCP bleeding. However, there was no significant difference in overall adverse events between shorter and longer procedures.