Introduction ERCP remains an important diagnostic and therapeutic tool for the management of biliary and pancreatic diseases. In the UK this is mainly performed using conscious sedation but there appears to be an increasing need for deeper sedation and general anaesthesia. Since 2009 there has been a regular fortnightly list for provision of general anaesthetic to assist ERCP particularly for complex interventions in our unit. We report our experience of ERCP performed under general anaesthetic (GAERCP).
Method Retrospective analysis of all patients who underwent ERCP in our centre was performed using the Unisoft reporting tool over the period June 2008 to December 2014. Patient demographics, indication for ERCP, indication for GA, complication rate and Cotton complexity scores were recorded. Trends in numbers of patients undergoing ERCP under GA, complications rates and complexity scores were calculated and comparison made to patients undergoing ERCP under sedation.
ResultsOver the study period 2797 patients (1165 males, median age 69 years) under went ERCP of which 159 (5.7%) were under general anaesthetic. Those undergoing GAERCP were significantly younger than those having sedation (mean age 54.9 vs. 65.7 years, p < 0.0001). Complexity scores were significantly higher in those undergoing GAERCP compared to sedation cases (median 3 vs 1, p < 0.05). Over the study period total numbers of ERCP rose but proportionally GAERCP also significantly increased (1.3% in 2008 to 6.7% in 2014, p < 0.001). Indications for GAERCP included previously failed (n = 38), patient preference/factors (n = 31), Spyglass (n = 28), pancreatic therapy (n = 19), biliary manometry (n = 17), complex stone disease (n = 11), ITU patient (n = 10), Bilroth II anatomy (n = 4), PSC with stricture (n = 1), ampullectomy (n = 1) and minor papilla procedure (n = 1). Successful completion rates at GAERCP improved from 75% in 2009 to 91.4% in 2014 (p = 0.019). Complication rate was 6.9% overall compared to 6.1% in the sedation group but the pancreatitis rate was higher (5.7% vs. 2.1%, p = 0.03) mainly in manometry patients.
Conclusion There is an increasing need for ERCP under general anaesthetic particularly to cater for more complex and higher risk interventions. This can be achieved with a high completion rate but with a higher, but acceptable rate of post procedural pancreatitis.
Disclosure of interest None Declared.
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