Outpatient therapeutic ERCP: a series of 262 consecutive cases

Is outpatient ERCP suitable, feasible, and safe? The experience of a Spanish community hospital

“…Fifty-six (25.5%) patients were admitted to the hospital during the observation period, which was in the high end of the range of published reviews (3.4-25.1%) [9,10,14,17] and related to the pathological findings found during the ERCP. Therefore, we had to admit those patients into the hospital, or readmit those patients who had previously been discharged, while we tried to finish the study on an outpatient basis.…”

“…Only two (7.4%) patients developed complications after discharge (1 cholangitis and 1 pancreatitis), which resolved with standard medical treatment. It is reported in the literature [6,7,9,14,15] that 72-84% of admissions are direct hospital admissions due to complications that appeared within the first few hours after surgery, and only 2-12% of patients had to be readmitted after discharge due to later complications [6,8,13,14,17]. Therefore, it seems that an observation period of 2-6 h is sufficient to detect most complications.…”

“…Admission of a patient before or immediately after an ERCP procedure in order to improve the detection of complications that may arise has been and still is standard operating procedure for many hospitals despite the shortage and the cost of hospital beds. This situation is not new [6][7][8][9] and continues to be of great interest 20 years after the first outpatient ERCP procedure was reported [10].…”

“…For a few years now ERCP have been performed on an outpatient basis with short observation periods in the treatment of choledocholithiasis [8], in the palliative treatment of malignant biliary stenosis with stent placement [11], and for other indications [9,10,[12][13][14][15][16]. Observation periods ranged from 2 to 4 h [8-10, 16, 17] and 6 or more hours [6,14,15].…”

Predicting Endoscopic Sphincterotomy-Induced Pancreatitis Using Serum Amylase Levels

“…There are now several studies in the literature suggesting that selected patients undergoing therapeutic ERCP can be safely discharged after a 2-to 4-h observation period with specific instructions to call or return to the hospital if signs and symptoms of a complication develop (1)(2)(3)(4)(5)(6)(7). In these studies, patients were discharged based on clinical criteria alone-absence of pain, fever, nausea, vomiting, unstable vital signs, or prolonged sedation.…”