S3238 Outcomes of Therapeutic Endoscopic Retrograde Cholangiopancreatography in a Community Hospital Setting

Abstract

INTRODUCTION: ERCP is a complex endoscopic procedure that requires dedicated training and carries a high risk of adverse events. Most published data on outcomes and treatment strategies are from academic institutions. Community-based hospitals are prevalent and provide access to ERCP for acute pancreaticobiliary issues. ERCP outcomes in this setting are unknown. The aim of this study was to determine ERCP outcomes in a community setting, with particular attention to the 30-day adverse event rate. METHODS: This was a single-center, retrospective, non-controlled study of patients undergoing ERCP at Naples Community Hospital in Naples, Florida. Four gastroenterologists have ERCP privileges. Data were collected from January 1, 2016, to December 31, 2017. The success rate was calculated in cases where appropriate papilla position was obtained. If cannulation was attempted the procedure was included. A therapeutic ERCP was defined as a procedure that included a sphincterotomy, stent placement/removal, dilation, or retrieval of a stone. Technical success was defined when cannulation, stone removal, or drainage was successful. Cannulation was considered successful when the tip of the catheter was passed beyond the papilla into the desired duct. Demographics, indication, findings, and adverse events were recorded. RESULTS: A total of 284 therapeutic ERCP procedures were performed. Fifty-four percent of the patients (n = 154) were male, median age 72 years (range 17-98 years), and median BMI 26 (range 13-50). The most common indication for ERCP was choledocholithiasis without cholangitis 48% (n = 137). The overall adverse event rate was 16% (n = 46). Post ERCP pancreatitis (PEP) occurred in 14% (n = 42), post sphincterotomy bleeding 3% (n = 9), and bile duct perforation 0.07% (n = 2). There were no deaths. Sixty-one percent (n = 174) of patients received 100 mg rectal indomethacin. Biliary and pancreatic cannulation was successful in 94% (n = 257). Precut papillotomy was performed in 1% of cases (n = 3; Table 1). Only periprocedural rectal indomethacin was associated with a reduced incidence of PEP in both univariate and multivariate logistic regression analysis (Table 2). CONCLUSION: This is the first study at our community hospital to explore the indications and outcomes of ERCP. We found a higher rate of PEP compared to quoted rates from large academic centers, but with comparable technical success rates. This may be due to volume and level of experience, factors that deserve further exploration in larger, future studies.Table 1.: Demographics, Indications and Technical characteristicsTable 2.: Predictors of Post ERCP pancreatitis