Endoscopic Retrograde Cholangiopancreatography For Choledocholithiasis Research Articles

Endoscopic ultrasound-guided antegrade treatment versus balloon enteroscopy endoscopic retrograde cholangiopancreatography for choledocholithiasis in patients with Roux-en-Y gastric bypass: a systematic review and meta-analysis.

The safety and technical success of endoscopic ultrasound-guided antegrade treatment (EUS-AG) compared to balloon enteroscopy-assisted endoscopic cholangiopancreatography (BE-ERCP) for choledocholithiasis in Roux-en-Y gastrectomy has not been well documented. We performed a systematic review and meta-analysis to assess the safety and efficacy of the 2 procedures. A systematic search of multiple databases was undertaken through January 25, 2024, to identify relevant studies comparing the 2 procedures. Standard meta-analysis methods were employed using a random-effects model. For each outcome, risk-ratio (RR), 95% confidence interval (CI), and P-values were generated. P<0.05 was considered significant. Heterogeneity was assessed using the I 2 statistic. Three studies with 795 patients (95 in the EUS-AG group and 700 in the BE-ERCP group) were included. The technical success rate was similar between EUS-AG and BE-ERCP (RR 1.08, 95%CI 0.84-1.38; P=0.57; I 2=56%). The overall rate of adverse effects was higher in the BE-ERCP group than in the EUS-AG group (RR 1.95, 95%CI 1.21-3.15; P=0.006; I 2=0 %). Rates of clinical success, pancreatitis, perforation, and bile peritonitis were similar between the 2 procedure techniques. Our analysis showed no distinct advantage in using one technique over the other for patients with Roux-en-Y anatomy in achieving technical and clinical success. However, the incidence of adverse effects was greater in the BE-ERCP group than in the EUS-AG group.

The Clinical Presentations of Liver Abscess Development After Endoscopic Retrograde Cholangiopancreatography with Choledocholithiasis: A 17-Year Follow-Up.

Endoscopic Retrograde Cholangiopancreatography (ERCP), used for choledocholithiasis treatment, carries a risk of pyogenic liver abscess (PLA) due to communication between the biliary system and bowel contents. However, limited data exists on this issue. This study aims to identify the risk factors pertaining to liver abscesses following ERCP lithotomy. We conducted a retrospective case series across multiple centers to evaluate patients who developed PLA after ERCP for choledocholithiasis. Data was obtained from the Chung Gung Research Database (January 2001 to December 2018). Out of 220 enrolled patients, 195 were categorized in the endoscopic sphincterotomy (ES) group, while 25 were in the non-ES group for further analysis. The non-ES group had significantly higher total bilirubin levels compared to the ES group (4.3 ± 5.8 vs 1.9 ± 2.0, p<0.001). Abscess size, location, and distribution (single or multiple) were similar between the two groups. The most common pathogens were Klebsiella pneumoniae and Escherichia coli. Pseudomonas infection was significantly less prevalent in the ES group compared to the non-ES group (3.6% vs 16.7%, p=0.007). Patients with concurrent malignancies (HR: 9.529, 95% CI: 2.667-34.048, p=0.001), elevated total bilirubin levels (HR: 1.246, 95% CI: 1.062-1.461, p=0.007), multiple abscess lesions (HR: 5.146, 95% CI: 1.777-14.903, p=0.003), and growth of enterococcus pathogens (HR: 4.518, 95% CI: 1.290-15.823, p=0.001) faced a significantly higher risk of in-hospital mortality. PLA incidence was higher in the ES group compared to the non-ES group following ERCP for choledocholithiasis. Attention should be given to significant risk factors, including concurrent malignancies, elevated total bilirubin levels, multiple abscess lesions, and growth of enterococcus pathogens, to reduce in-hospital mortality.

Effect of rectal indomethacin on the prevention of pancreatitis after endoscopic retrograde cholangiopancreatography for choledocholithiasis: a prospective randomized clinical trial.

the aim of this study was to evaluate the efficacy and safety of rectal indomethacin for the prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) in patients with common bile duct (CBD) stones. a total of 167 patients undergoing ERCP between November 2019 and November 2022 for CBD stones in the First Affiliated Hospital of Dalian Medical University were prospectively analyzed. The patients were divided into an indomethacin group (n = 58) and a control group (n = 109). The primary endpoint was the percent of patients who experienced PEP. PEP was observed in a total of 26 patients (15.57 %); four patients (6.90 %) in the indomethacin group and 22 (20.18 %) in the control group (p = 0.042). Mild, moderate and severe PEP was observed in three (5.17 %), one (1.72 %) and zero patients, respectively, in the indomethacin group, and in eleven (10.09 %), nine (8.26 %) and two (1.83 %) patients, respectively, in the control group. There was one case (0.92 %) of death due to PEP in the control group. No cases of moderate or severe bleeding were observed in either group. rectal indomethacin is an effective and safe method to prevent PEP for patients with CBD stones undergoing ERCP.

OGBN P06 Expectant Management Following Endoscopic Sphincterotomy for Choledocholithiasis: Is It Safe?

Abstract Background Gallstone disease is one of the most common gastrointestinal conditions in the UK. It is estimated that 10–15% of adults in the UK have gallstones. Most gallstones are found in the gallbladder but sometimes they can pass through the cystic duct into the common bile duct (CBD) causing choledocholithiasis. CBD stones may present with symptoms of jaundice, cholangitis, pancreatitis or be asymptomatic. Endoscopic sphincterotomy (ES), first reported in 1974, is considered a safe and effective method for managing choledocholithiasis. A significant proportion of patients who undergo ES for symptomatic CBD stones are subsequently referred for cholecystectomy. However, it is unclear whether cholecystectomy itself is necessary after endoscopic CBD stone removal. Some studies recently have indicated that cholecystectomy may not always be needed following endoscopic duct clearance (expectant management), especially for patients that remain asymptomatic or decline surgery (due to frailty, significant comorbidities or patient choice). The primary aim of this study was to assess the outcomes of patients who had expectant management (EM) after endoscopic CBD stone removal. Methods We retrospectively analysed the records of patients who underwent Endoscopic Retrograde Cholangiopancreatography (ERCP) in a UK District General Hospital between 01 January 2019 and 31 December 2019. Inclusion criteria were a) presence of CBD stones, and b) patients who underwent ERCP without prior cholecystectomy. The following patients were excluded: a) previous cholecystectomy, b) patients who underwent ERCP for other biliary pathologies, including malignancy. The original data set was obtained from the clinical coding department. ERCP reports, clinic letters, discharge summaries and the hospital results reporting systems were reviewed to extract patient data including demographics, comorbidities, management decision following ERCP, need for repeat ERCP and readmission rate. Results A total of 220 patients underwent ERCP in 2019. After excluding patients who did not fit the inclusion criteria,106 patients were included in this study. The median age was 75 years (22–97). 60 patients were women and 46 were men. Median follow up period was 36 months (30–42), excluding patients who died within the follow up period. 63 (59%) patients had a course of expectant management following ERCP for choledocholithiasis while 43 (41%) had a planned cholecystectomy (CS). Of the sixty-three patients who had EM, 40 were considered unfit for surgery, 18 were asymptomatic following ERCP, 3 did not wish to have surgery and the reason is unknown in 2. The median age for EM patients was 80 years (22–91), whereas the CS group had a median age of 62 years (25–82). In the EM group, 11 patients passed away within the follow-up period, none related to biliary pathology. Of the remaining 52 patients, only 1 proceeded to have cholecystectomy during the 3 year follow-up period due to multiple episodes of cholangitis. 2 out of 52 (4%) were readmitted with biliary complications but they continued to be managed conservatively due to frailty. Conclusions Endoscopic sphincterotomy and clearance of ductal stones followed by cholecystectomy is the most common treatment for choledocholithiasis. Recent NICE guidelines recommend CS for all patients with symptomatic or asymptomatic CBD stones. However, there is minimal evidence regarding the safety of leaving the gallbladder in situ after ES and thus the issue remains debatable. The majority of studies that have evaluated the complication rates of EM have focused only on elderly patients (age&amp;gt;80years), whereas our study has evaluated all patients after ERCP regardless of age and comorbidities. Pancreatitis did not occur during follow-up in any patients without cholecystectomy. This is in keeping with previous evidence as ES may in itself be definitive in prophylaxis against pancreatitis as it decreases the risk of pancreatic duct obstruction. The majority of patients (95%) with choledocholithiasis who did not undergo cholecystectomy after ERCP remained asymptomatic, indicating that expectant management is safe. However, we recognise this was a single centre study with limited patient numbers and medium-term follow-up. We suggest that future randomized controlled trials be multicentre and should include an assessment of patients’ quality of life and non-hospital managed symptoms.

The role of preventive pancreatic duct stent placement in preventing acute pancreatitis after endoscopic retrograde cholangiopancreatography

The aim of this study was to investigate the preventive effect of pancreatic duct stent on acute pancreatitis after endoscopic retrograde cholangiopancreatography. A retrospective analysis of the case data of patients who first underwent endoscopic retrograde cholangiopancreatography for choledocholithiasis in the Beijing Friendship Hospital from January 2015 to December 2019 for 5 years. According to whether the pancreatic duct stent was indwelled during the operation, they were divided into pancreatic duct stent group (147 cases) and non-indwelling pancreatic duct stent group (192 cases). The incidence of acute pancreatitis after endoscopic retrograde cholangiopancreatography was compared between the two groups according to COTTON criteria. Independent sample t test, Pearson Chi-square test (χ2) and Fisher's exact test were used to compare groups' differences. There were 2 cases of acute pancreatitis in the pancreatic duct stent group, all of which improved after 48 hours. There were 22 cases of acute pancreatitis in the non-indwelling pancreatic duct stent group, of which 20 cases improved within 48 hours, and the other 2 cases had severe pancreatitis, which improved and discharged after 30 days of treatment. There was significant difference in the incidence of acute pancreatitis between the pancreatic duct stenting group (1.4%) and the group without placement of pancreatic duct stents (11.5%) (χ²=12.905,P<0.001). In conclusion, Pancreatic duct stent may be an effective method to prevent PEP.

Choledocholithiasis: Long-term follow-up in patients without stone clearance at first endoscopic retrograde cholangiopancreatography.

Complete clearance during endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis is not always successful and biliary stenting is commonplace. Strategies vary between temporary stent placement (TSP) with interval ERCP or permanent stent placement (PSP) and watchful waiting for recurrent biliary obstruction (RBO). This study aimed to describe outcomes in these two groups and stent patency rates in PSP. Patients with incomplete clearance at first ERCP for choledocholithiasis between May 2015 and December 2018 were identified. Clinical outcomes were obtained by retrospective interrogation of the case notes. Median follow-up duration was 41 months (interquartile range 29-51 mo). Of 1263 index ERCP, 199 (15.8%) had no stone clearance, with 53.3% receiving PSP and 46.7% undergoing TSP. The TSP group had repeat ERCP after a median of 8 weeks; 75.3% had clearance on a repeat ERCP. The PSP group was elder than the TSP group (82 y vs 72 y, P < 0.001). The rates of RBO (32.1% vs 16.1%) and emergency readmissions (32.1% vs 19.4%) were higher in the PSP group (both P < 0.05). More patients died without further biliary disease in the PSP group (39.6% vs 12.9%, P=0.001). PSP stent patency rates at 6, 12, 24, 36, and 61 months were 87.7%, 82.1%, 75.5%, 69.8% and 67.9%, respectively. Though PSP had higher RBO and emergency readmissions, two-thirds of patients either died or survived without recurrent biliary disease. Stent patency decreased fastest in the first 12 months. Criteria to guide decision-making for biliary stenting remain unclear.

Same day endoscopic retrograde cholangio-pancreatography immediately after endoscopic ultrasound for choledocholithiasis is feasible, safe and cost-effective

Background Patients with suspected choledocholithiasis should undergo further confirmatory imaging test by endoscopic ultrasound (EUS) or magnetic resonance cholangiopancreatography (MRCP) before performing definite extraction by endoscopic retrograde cholangiopancreatography (ERCP). Usually, those procedures are performed at a separate session. Aim The aim of our study is to report the safety, efficacy and cost-effectiveness of same day EUS and ERCP. Methods A retrospective study including all patients who underwent EUS and ERCP for choledocholithiasis from 1st January 2020 through 1st January 2021. Patients were categorized into same day EUS and ERCP (group A) and separate day procedures (group B). Univariate descriptive analysis was done to compare between the groups and cost-effectiveness analysis was based on the length of hospitalization. Results Sixty-one patients (57.5%) underwent same day EUS and ERCP (group A), as compared to 45 patients (42.5%) who had separate sessions (group B). The average ages in groups A and B were 66.1 ± 20.7 years and 65.8 ± 19.3 years, respectively (p = .47). There was no difference in the mean doses of midazolam, propofol and fentanyl in EUS and ERCP examinations in both groups. Notably, group A had a significantly lower hospitalization length as compared to group B (7.4 ± 2.9 vs. 9.7 ± 3.9 days, p = .0003). Consequently, same day EUS and ERCP was associated with a significant cost saving as compared to group B (7680.9$ ± 3071.4$vs 10089.4$±4053.4$, p = .0003), respectively. There was no serious anesthesia related adverse events. Conclusion Same day EUS and ERCP for choledocholithiasis was safe and cost-effective with significant lower hospitalization length.

Long-term Outcomes of Therapeutic Endoscopic Retrograde Cholangiopancreatography for Choledocholithiasis in Patients ≥90 Years Old: A Multicenter Retrospective Study.

Objective The safety and prognosis of complete stone removal for the treatment of choledocholithiasis in older patients are unknown. This multicenter retrospective study assessed the outcomes of complete stone removal in elderly patients (≥90 years) with respect to the prognosis. Methods We divided patients who underwent endoscopic cholangiopancreatography for choledocholithiasis into two groups: complete stone removal or incomplete stone removal with plastic stent insertion. The patient characteristics, adverse events, number of endoscopic cholangiopancreatographies, overall survival rates, and disease-specific cumulative death were compared between the groups. Patients Two hundred and twenty-three participants ≥90 years old were included in the study, including 48 (22%) men and 175 (78%) women. The median age was 92 (range, 90-104) years old. There were 160 (72%) and 63 (28%) patients in the complete and incomplete groups, respectively. Results The age, performance status, comorbidities, severe complication rates, and stone diameter were comparable between the groups. The proportion of patients with at least 5 stones was significantly higher in the incomplete group than in the complete group [complete group: 8.1% (13/160) and incomplete group: 21% (13/63), p<0.01]. The overall survival rate was significantly higher in the complete group (p<0.01), while the disease-specific cumulative death rate was higher in the incomplete group (p<0.01). Conclusion Complete stone removal for choledocholithiasis may contribute to a better prognosis in elderly patients ≥90 years old.

42 Safety of Endoscopic Retrograde Cholangiopancreatography for Choledocholithiasis in Patients With Age ≥80: A Nationwide Analysis

INTRODUCTION: Endoscopic retrograde cholangiopancreatography (ERCP) is a necessary procedure for exploration and management of pancreaticobiliary ductal system disorders. Safety of ERCP in the elderly population with more underlying co-morbidities remains a concern. We aimed to study if ERCP, particularly for biliary calculus (BC)-related indications, is associated with higher complications including mortality in patients with age ≥80. METHODS: We performed a retrospective analysis using data from the National Inpatient Sample (NIS) from the year 2016. We included all adult patients admitted with BC who underwent ERCP, and we further identified those with concurrent pancreatitis and/or cholangitis, using ICD-10-CM codes. Patients with missing information on age, gender or inpatient mortality were excluded. We analyzed patients by two groups: age &lt;80 and ≥80 years. Chi-square analysis and t-tests were used to compare categorical and continuous variables, respectively. Predictors of ERCP-related complications, including inpatient mortality, were assessed by multivariable logistic regression analysis. RESULTS: Total of 102,095 patients were included in the study who underwent ERCP for BC related etiology, out of which 20,530 (20.1%) were patients age ≥80 years. In the age ≥80 group, mean age was 85.4 years, and 56.5% patients were female. Unadjusted mean length of stay (6.3 vs. 5.3 days), hospitalization costs ($75,326 vs. $72,110) and inpatient mortality (2.2% vs. 0.8%) were significantly higher in patients with age ≥80. BC without pancreatitis or cholangitis was the most common indication for ERCP in both groups. Prevalence of complications related to ERCP were comparable between two groups except for cardiorespiratory complications and mortality (Table 1). On multivariate analysis, patients with age ≥80 had statistically no significant difference in complications in compared to patients with age &lt;80 years (aOR: 0.96, 95% CI 0.92–1.01, P = 0.133). Among all patients, ERCP performed for biliary pancreatitis (BP) had 70% lower rate of complications while ERCP for cholangitis had 26% higher rate compared to ERCP for simple BC (Table 2). CONCLUSION: In the United States, about 1 in 5 ERCP for BC are performed in patients with age ≥80. Overall, BP is associated with significantly lower risk of complications. Among patients undergoing ERCP for BC-related indications, patients with age ≥80 do not carry a higher risk of ERCP-associated complications.

Multidisciplinary Approach to Treating Severe Acute Pancreatitis in a Low-Volume Hospital.

Up to 25% of patients with acute pancreatitis develop severe complications and are classified as severe pancreatitis with a high death rate. To improve outcomes, patients may require interventional measures including surgical procedures. Multidisciplinary approach and best practice guidelines are important to decrease mortality. We have conducted a retrospective analysis from a prospectively maintained database in a low-volume hospital. A total of 1075 patients were attended for acute pancreatitis over a ten-year period. We have analysed 44 patients meeting the criteria for severe acute pancreatitis and for intensive care unit (ICU) admittance. Demographics and clinical data were analysed. Patients were treated according to international guidelines and a multidisciplinary flowchart for acute pancreatitis and a step-up approach for pancreatic necrosis. Forty-four patients were admitted to the ICU due to severe acute pancreatitis. Twenty-five patients needed percutaneous drainage of peri-pancreatic or abdominal fluid collections or cholecystitis. Eight patients underwent endoscopic retrograde cholangiopancreatography for choledocholithiasis and biliary sepsis or pancreatic leakage, and one patient received endoscopic trans-gastric endoscopic prosthesis for pancreatic necrosis. Sixteen patients underwent surgery: six patients for septic abdomen, four patients for pancreatic necrosis and two patients due to abdominal compartment syndrome. Four patients had a combination of surgical procedures for pancreatic necrosis and for abdominal compartment syndrome. Overall mortality was 9.1%. Severe acute pancreatitis represents a complex pathology that requires a multidisciplinary approach. Establishing best practice treatments and evidence-based guidelines for severe acute pancreatitis may improve outcomes in low-volume hospitals.

Safety and Efficacy of Endoscopic Retrograde Cholangiopancreatography for Choledocholithiasis in Long-Term Dialysis: A Propensity Score Analysis.

Previous studies evaluating the safety of endoscopic retrograde cholangiopancreatography (ERCP) in patients with end-stage renal disease (ESRD) undergoing hemodialysis reported an increased risk of post-procedural bleeding. We investigated the safety and efficacy of ERCP for the treatment of choledocholithiasis in patients with ESRD undergoing long-term dialysis. A total of 3466 patients who underwent ERCP due to choledocholithiasis between January 2000 and Feb 2018 were reviewed and analyzed retrospectively. Patients were divided into dialysis and non-dialysis group, and propensity score matching was used to minimize selection bias. Patients of dialysis group (n = 39) and non-dialysis group (n = 78) were compared after propensity score matching. Among 39 patients of dialysis group, hemodialysis was used in 28 (71.8%) patients for renal replacement therapy, while 11 (28.2%) patients received peritoneal dialysis. The median duration of dialysis was 8years (range 1-24years). Overall success rate of ERCP was not different between two groups. The overall prevalence of post-procedural complications in dialysis group and non-dialysis group was 28.2 and 15.4%, respectively (p = 0.100). Post-procedural bleeding occurred more frequently in dialysis group than non-dialysis group (23.1 vs 5.1%, p = 0.004). All procedure-related bleeding episodes were successfully controlled using endoscopic management. Prevalence of post-ERCP pancreatitis, infection, and perforation were not significantly different between two groups (p > 0.05). Overall success rate of complete ductal clearance was not different between dialysis and non-dialysis groups. The risk of post-procedural bleeding seems to be increased in patients with ESRD undergoing long-term dialysis.

Discussion of: “Laparoscopic common bile duct exploration versus endoscopic retrograde cholangiopancreatography for choledocholithiasis found at time of laparoscopic cholecystectomy: Analysis of a large integrated health care system database”

Abstract Background We compared endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic common bile duct exploration (LCBDE) for managing choledocholithiasis found at time of cholecystectomy. Methods One hundred and five LCBDE (2005–2015) were compared to 195 LC/ERCP (2014–2015) from the Southern California Kaiser Permanente database. Results LC/ERCP was more effective at clearing the CBD (98% vs. 88.6%, p = 0.01); but required more procedures per patient (mean ± standard deviation, 1.1 ± 0.4 vs. 2.0 ± 0.12, p 0.05). Four patients failed ERCP, while 12 patients failed LCBDE and had subsequent ERCP (10) or CBD exploration (2). All patients with RYGB had successful LCBDE. Conclusion LC/ERCP is better than LCBDE in clearing CBD stones, but has similar morbidity and is an effective alternative for patients with RYGB.

Laparoscopic common bile duct exploration versus endoscopic retrograde cholangiopancreatography for choledocholithiasis found at time of laparoscopic cholecystectomy: Analysis of a large integrated health care system database

BackgroundWe compared endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic common bile duct exploration (LCBDE) for managing choledocholithiasis found at time of cholecystectomy. MethodsOne hundred and five LCBDE (2005–2015) were compared to 195 LC/ERCP (2014–2015) from the Southern California Kaiser Permanente database. ResultsLC/ERCP was more effective at clearing the CBD (98% vs. 88.6%, p = 0.01); but required more procedures per patient (mean ± standard deviation, 1.1 ± 0.4 vs. 2.0 ± 0.12, p < 0.001). Morbidity, hospital length of stay and readmission were not different (P > 0.05). Four patients failed ERCP, while 12 patients failed LCBDE and had subsequent ERCP (10) or CBD exploration (2). All patients with RYGB had successful LCBDE. ConclusionLC/ERCP is better than LCBDE in clearing CBD stones, but has similar morbidity and is an effective alternative for patients with RYGB.

Risk factors of selective biliary cannulation in endoscopic retrograde cholangiopancreatography for choledocholithiasis and the value of assistant cannulation methods

Objective To investigate the risk factors of standard selectivity biliary cannulation in endoscopic retrograde cholangiopancreatography (ERCP) for patints with choledocholithiasis, and the effect and safety of assistant cannulation methods. Methods The clinical data were retrospectively analyzed in 372 patients, who received ERCP for choledocholithiasis in the Yijishan Hospital of Wannan Medical College from January 2014 to December 2014. The risk factors of standard biliary cannulation were assessed by univariate and multivariate logistic regression analysis. The success rate of assistant biliary cannulation and the incidence of post-ERCP pancreatitis (PEP) of standard biliary cannulation were compared with double-guide wire technique (DGT) and precut sphincterotomy (PS), which were used when standard biliary cannulation failed. Results The univariate analysis showed that floppy and long duodenal papilla(P=0.000), angulated common bile duct(P=0.013) were related to failure of standard biliary cannulation.Multivariate analysis showed that floppy and long papilla (P=0.000, OR=0.131, 95%CI: 0.056-0.307), angulated common bile duct (P=0.003, OR=0.378, 95%CI: 0.197-0.726) were independent risk factors for standard biliary cannulation. The success rate of standard biliary cannulation was 83.3% (310/372), 62 cases undergone DGT or PS after standard biliary cannulation failure, and the total success rate of cannulation was 99.7% (371/372). There were 29 cases suffered from PEP in 371 successful cases of biliary cannulation, including 18 cases (5.8%, 18/310) of standard biliary cannulation, 8 cases (16.3%, 8/49) of DGT, and 3 cases (25.0%, 3/12) of PS. The incidence of PEP by DGT (χ2=5.532, P=0.019) and PS (χ2=6.994, P=0.008) was significantly higher than that of standard biliary cannulation, but there was no statistical difference on the incidence of PEP between DGT and PS (χ2=0.079, P=0.778). Conclusion Floppy and long duodenal papilla and angulated common bile duct could easily induce the failure of standard biliary cannulation in ERCP for patients with choledocholithiasis. DGT and PS are effective assistant cannulation methods when the standard cannulation fails. Key words: Choledocholithiasis; Cholangiopancreatography, endoscopic retrograde; Intubation; Risk factors; Safety

Mo1425 Utilization Trends of Endoscopic Retrograde Cholangiopancreatography (ERCP) From 2000-2014 in a Large US Endoscopic Database

patient tolerance of procedure, technical success, and recovery time, and most are limited to single centers with few patients. Our aim was to assess utilization of deep sedation with propofol among inpatients undergoing ERCP for choledocholithiasis and compare outcomes of mortality, complications, length of stay (LOS), and hospitalization cost between those who received deep sedation and those who did not. Methods: This cross-sectional study included hospitalized patients with a diagnosis of choledocholithiasis who underwent ERCP between 2006 and 2012. Data was obtained from the Perspective database, a validated dataset of inpatient admissions from O500 hospitals nationwide created to measure quality and health care utilization. Patient and hospital characteristics were compared by Chi-square and t-tests, and multivariable analysis was used to determine the effect of deep sedation on outcomes of in-hospital mortality, complications, LOS, and hospitalization cost. Results: We identified 60,342 eligible patients, of which 26,244 (43.5%) had deep sedation with propofol. The proportion of ERCP cases with propofol increased from 28.8% (2006) to 53.2% (2012). Mean age of the population was 63.8 20.1 years (62.3 with propofol, 65.1 without, p!0.0001). Patient characteristics inversely associated with propofol use were older age, Medicare insurance, and multiple comorbidities. Hospital characteristics inversely associated with propofol use were teaching status and larger hospital size. In-hospital mortality following ERCP was 1.2% (1.1% with propofol, 1.3% without, p!0.0001), rate of any complication was 38.2% (37.2% with propofol, 39.0% without, p!0.0001), LOS was 6.1 days (6.1 with propofol, 6.2 without, pZ0.13), and hospitalization cost was $13,127 7,463 ($13,414 with propofol, $12,905 without, p!0.0001). Adjusting for patient and hospital characteristics on multivariable analysis, hospitalization cost was $759 greater with propofol (p!0.0001) but there were no differences in in-hospital mortality (OR 0.97 95% CI 0.83-1.12), rate of any complication (OR 1.02 95% CI 0.991.06), and LOS (1.05 days more with propofol, 95% CI 0.96-1.14) between those who received propofol and those who did not. Conclusions: Utilization of propofol for ERCP in hospitalized patients with choledocholithiasis has increased. Selection of patients for deep sedation with propofol should be based on patient characteristics, irrespective of hospital characteristics and resources, as clinical outcomes are comparable and hospitalization cost differences are negligible.

Outcome of Staged Bilateral Knee Replacement

Outcome of Staged Bilateral Knee Replacement

Management of Patients Following Endoscopic Retrograde Cholangiopancreatography for Choledocholithiasis

Management of Patients Following Endoscopic Retrograde Cholangiopancreatography for Choledocholithiasis

Intraoperative rendezvous endoscopic retrograde cholangiopancreatography for choledocholithiasis: what about big stones?

Intraoperative rendezvous endoscopic retrograde cholangiopancreatography for choledocholithiasis: what about big stones?

Expectant treatment of cholecystectomy after endoscopic retrograde cholangiopancreatography for choledocholithiasis in patients over 80 years of age

Expectant treatment of cholecystectomy after endoscopic retrograde cholangiopancreatography for choledocholithiasis in patients over 80 years of age

Expectant treatment or cholecystectomy after endoscopic retrograde cholangiopancreatography for choledocholithiasis in patients over 80 years old?

It is recommended that most patients between 18-80 years old, who have had an endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis, should be offered cholecystecytomy. However, we were uncertain whether this was the correct advice for patients over 80. A retrospective case note analysis was performed on 81 patients over 80, who had had an ERCP for choledocholithiasis. The primary end points were further biliary symptoms, cholecystectomy, death from biliary independent causes, and those still alive without further biliary symptoms. The records of 81 patients (median age 87; range, 80-96 years) were analyzed. Of the patients, 11% experienced further biliary symptoms at a median time of 4.5 months [interquartile range (IQR), 2.25-8.5 months] from the ERCP; 6% received cholecystectomy; 61% were still alive with no further biliary symptoms at a median time of 17 months (IQR, 12.25-23.75 months) after ERCP; and 22% had died from biliary independent causes at a median time of 9 months after ERCP (IQR, 3-12 months). Expectant treatment can be recommended in this group of patients. Those who do present with further biliary symptoms do so soon after ERCP. Therefore, we recommend follow-up for 12 months after ERCP, prior to discharge.