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Endoscopy I
PMO-195 Is there optimum period of observation post daycase ERCP? 12 Month experience in a large non-tertiary centre
  1. A Singhal1,
  2. A Jayachandran2,
  3. R Faizallah1
  1. 1Gastroenterolgy, Wirral NHS Teaching Hospitals, Wirral, UK
  2. 2Acute Medicine, Wirral NHS Teaching Hospitals, Wirral, UK

Abstract

Introduction Daycase ERCP is practised in approximately 50% centres in UK. Even in these centres there is no uniform policy for post ERCP observation or duration of hospital stay. We established daycase ERCP service in January 2010 on the Wirral, catering to 360 000 population and hereby present our experience over a 12-month period.

Methods Data from Unisoft, GI Endoscopy reporting tool, was analysed to identify all the daycase ERCPs performed from 1 January to 31 December 2010. All the patients who for any reason stayed overnight after ERCP or re-attended hospital within 7 days, were identified from day ward registry and patient administrative system. Medical notes of all these patients were reviewed. All patients were closely monitored post ERCP in medical day ward for 4 h and were then allowed to eat and drink if there were no concerns. All patients were seen by the ERCPist prior to discharge.

Results Total of 395 ERCPs were performed by three endoscopists in this period of which 195 (48%) were as daycases. Difficulty level in all cases was Level 1–2 as per cotton et al. Indication of ERCP was pancreato biliary malignancy in 29 (15%), stone disease in 160 (82%) and previous bile leak 6 (3%) patients. All procedures in our unit are done with therapeutic intent. 137 (72%) patients underwent sphincterotomy and/or stent insertion. Previously placed stents were removed in the rest along with balloon trawl/stone extraction as needed. In all 32 (16.4%) patients were admitted overnight. Of these, 13 (6.6%) were elective admissions due to patient choice such as those who were elderly and lived alone. There were 7 (3.5%) complications including 3 mild cholangits, 1 moderate cholangitis, 1 mild and 1 severe pancreatitis and 1 death as per accepted guidelines by Cotton et al. One patient who died, chose to stay back electively but died 12 h later with pulmonary embolism. Rest 13 (6.6%) cases were advised to stay overnight because of suspected adverse event (commonest being post ERCP pain in 10 cases) but this was not substantiated on further investigations. Only one out of 195 patients (0.5%), presented within 7 days with procedure related complication, namely mild cholangitis. Overall there were 8 (4%) complications in 195 daycase ERCPs. Out of these 8, only 2 (25%) presented within 0–2 h, 4 (50%) in 2–6 h and rest 2 (25%) after 12 h of the procedure.

Conclusion Daycase ERCP is a safe service. We propose that patients should be kept nil by mouth for 4 h post procedure and observed upto 6 h on the daycase unit. It is good practise for patients to be seen by the ERCPist prior to discharge. This would pick up majority of procedure related complications and enhances patient satisfaction.

Competing interests None declared.

Reference 1. Williams E, et al. BSG audit of ERCP. Gut 2007;56:821–9.

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