The safety of diagnostic and therapeutic ERCP as a daycase procedure with a selective admission policy.

Abstract

To assess if therapeutic endoscopic retrograde cholangiopancreatography (ERCP) as a daycase procedure with a selective admission policy is safe and cost-effective. An audit of case notes of patients who attended as a daycase for either a therapeutic or diagnostic ERCP over a 20-month period. Stoke-on-Trent District General Hospital. Case notes of all patients who had an ERCP as a daycase were audited. Therapeutic procedures performed as daycases included papillotomy, stent insertion, balloon dilatation or a combination of these procedures. Patients are discharged home 2 h after diagnostic or therapeutic ERCP. Thirty-day morbidity and mortality of daycase patients. During the 20-month period audited, 550 ERCPs were performed, of which 240 attended initially as daycases. There were 97 successful daycase therapeutic ERCPs. Ten patients were admitted immediately after ERCP including one who subsequently died from a myocardial infarction (known severe ischaemic heart disease); 87 patients were discharged 2 h after ERCP; none were admitted between 2 and 48 h after ERCP; 4 were admitted between 48 h and 30 days after ERCP with complications. There were 117 successful daycase diagnostic ERCPs; 4 patients were admitted immediately due to frailty, 4 were admitted between 2 and 48 h and 1 at 28 days after ERCP with complications. There were 24 failed diagnostic and 2 failed therapeutic ERCPs. Daycase ERCP with a selective admission policy is safe and cost-effective.