Indications for and results of urgent ERCP

K. J. Casey, K. Mergener, P. S. Jowell, M. S. Branch, John Paul Affronti, J. Baillie

Research output: Contribution to journalArticle

Abstract

Background: Cholangitis, severe gallstone pancreatitis, and bile duct injuries are indications for urgent endoscopic retrograde cholangio-pancreatography (ERCP). Performing ERCP "out of hours" has its problems as support personnel may not be available and procedure costs are increased. The outcomes associated with urgent ERCP have not been well defined. We examined indications for and outcomes of urgent ERCP performed at our tertiary care center. Methods: Urgent ERCPs performed out of routine endoscopy hours (8AM to 5PM, Monday to Friday) were identified from a computerized database. Medical charts and endoscopy records were reviewed. Results: Between 6/93 and 11/96, 2945 ERCPs were performed at our institution. Of these, 77 (2.6%) were characterized as urgent procedures. Indications included cholangitis (39/77;50.6%), obstructive jaundice without overt cholangitis (9/77; 11.7%), suspected bile duct injury (17/77; 20.7%), pancreatitis (9/77; 11.7%), hemorrhage after ERCP/sphincterotomy (1/77; 1.3%), and pain with abnormalities of liver function tests or imaging studies (2/77; 2.6%). ERCP was successful in 73/77 patients (94.8%). Failures were associated with duodenal stenosis (2) and post-operative anatomy (2). In patients with successful ERCP, a diagnosis was made in 71/73 cases. Therapeutic procedures were performed in 59/77 patients (76.6%). There was one death (1.3%); a patient with pancreatic cancer presented in shock from cholangitis due to biliary stent occlusion. Progressive hypotension during ERCP could not be reversed. Conclusions: Despite the logistical problems involved, urgent ERCP is safe and highly effective in a tertiary care setting for selected indications.

Original languageEnglish (US)
JournalGastrointestinal Endoscopy
Volume45
Issue number4
DOIs
StatePublished - Jan 1 1997

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Cholangitis
Endoscopic Retrograde Cholangiopancreatography
Bile Ducts
Pancreatitis
Endoscopy
Obstructive Jaundice
Liver Function Tests
Wounds and Injuries
Gallstones
Tertiary Healthcare
Pancreatic Neoplasms
Tertiary Care Centers
Hypotension
Stents
Shock
Anatomy
Databases
Hemorrhage
Costs and Cost Analysis
Pain

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

Cite this

Casey, K. J., Mergener, K., Jowell, P. S., Branch, M. S., Affronti, J. P., & Baillie, J. (1997). Indications for and results of urgent ERCP. Gastrointestinal Endoscopy, 45(4). https://doi.org/10.1016/S0016-5107(97)80404-X

Indications for and results of urgent ERCP. / Casey, K. J.; Mergener, K.; Jowell, P. S.; Branch, M. S.; Affronti, John Paul; Baillie, J.

In: Gastrointestinal Endoscopy, Vol. 45, No. 4, 01.01.1997.

Research output: Contribution to journalArticle

Casey, KJ, Mergener, K, Jowell, PS, Branch, MS, Affronti, JP & Baillie, J 1997, 'Indications for and results of urgent ERCP', Gastrointestinal Endoscopy, vol. 45, no. 4. https://doi.org/10.1016/S0016-5107(97)80404-X
Casey KJ, Mergener K, Jowell PS, Branch MS, Affronti JP, Baillie J. Indications for and results of urgent ERCP. Gastrointestinal Endoscopy. 1997 Jan 1;45(4). https://doi.org/10.1016/S0016-5107(97)80404-X
Casey, K. J. ; Mergener, K. ; Jowell, P. S. ; Branch, M. S. ; Affronti, John Paul ; Baillie, J. / Indications for and results of urgent ERCP. In: Gastrointestinal Endoscopy. 1997 ; Vol. 45, No. 4.
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abstract = "Background: Cholangitis, severe gallstone pancreatitis, and bile duct injuries are indications for urgent endoscopic retrograde cholangio-pancreatography (ERCP). Performing ERCP {"}out of hours{"} has its problems as support personnel may not be available and procedure costs are increased. The outcomes associated with urgent ERCP have not been well defined. We examined indications for and outcomes of urgent ERCP performed at our tertiary care center. Methods: Urgent ERCPs performed out of routine endoscopy hours (8AM to 5PM, Monday to Friday) were identified from a computerized database. Medical charts and endoscopy records were reviewed. Results: Between 6/93 and 11/96, 2945 ERCPs were performed at our institution. Of these, 77 (2.6{\%}) were characterized as urgent procedures. Indications included cholangitis (39/77;50.6{\%}), obstructive jaundice without overt cholangitis (9/77; 11.7{\%}), suspected bile duct injury (17/77; 20.7{\%}), pancreatitis (9/77; 11.7{\%}), hemorrhage after ERCP/sphincterotomy (1/77; 1.3{\%}), and pain with abnormalities of liver function tests or imaging studies (2/77; 2.6{\%}). ERCP was successful in 73/77 patients (94.8{\%}). Failures were associated with duodenal stenosis (2) and post-operative anatomy (2). In patients with successful ERCP, a diagnosis was made in 71/73 cases. Therapeutic procedures were performed in 59/77 patients (76.6{\%}). There was one death (1.3{\%}); a patient with pancreatic cancer presented in shock from cholangitis due to biliary stent occlusion. Progressive hypotension during ERCP could not be reversed. Conclusions: Despite the logistical problems involved, urgent ERCP is safe and highly effective in a tertiary care setting for selected indications.",
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