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Outcomes of Surgeon-Performed Endoscopic Retrograde Cholangiopancreatography
Edward L. Jones*, Teresa S. Jones, Sara E. Martin Del Campo, Michael P. Meara, Jeffrey W. Hazey, Vimal K. Narula
Surgery, The Ohio State University, Columbus, OH
Introduction: Endoscopic Retrograde Cholangiopancreatography (ERCP) is the standard for the diagnosis and/or management of biliary and pancreatic obstruction. In the United States, the procedure is performed by both surgeons and gastroenterologists. Upon review of the literature we could find no studies evaluating the overall outcomes of surgeon-performed ERCP. The aim of this study was to assess the outcome and complications following surgeon-performed ERCP.
Methods: We retrospectively reviewed all patients undergoing ERCP by a surgeon (JWH, VKN or MPM) between January 2006 and December 2014 at an academic medical center.
Results: One thousand one hundred and twenty-one patients underwent ERCP over an eight-year period. The mean age was 53.9 years and 533(48%) patients were male. (Table 1) The most common indication for ERCP was abnormal liver function test (637 patients, 57%) followed by abnormal imaging (282 patients, 25%). Most patients were underwent a therapeutic intervention (704 patients, 63%) and had not a pervious ERCP (773 patients, 69%). Successful cannulation was accomplished in 1,032 patients (92%). The mean procedure duration was 22.4±13 minutes. Post-procedure complications were noted 44 patients (3.9%). Thirty-five patients (3.1%) developed post-operative pancreatitis, 3 patients (0.3%) had bleeding required a blood transfusion, 6 patients (0.5%) developed cholangitis and there were no (0%) perforations. There were no ERCP-specific deaths within 30 days of the procedure.
Conclusions: Endoscopic Retrograde Cholangiopancretography is safe and effective in the hands of surgeons. The outcome and complications in our study were comparable to what is reported in the gastroenterology literature.
Patient Demographics
| Preoperative Variables | | Male | 533 (48%) | | Age (y) (mean) (SD) | 53.9 (18.6) | | ASS (median) | 2 | | History of Pancreatitis | 183 (16%) | | Total Bilirubin (mean) (SD) | 3.8 (5.0) | | Alkaline Phosphatase (mean) (SD) | 272.4 (707.9) | | Aspartate Transaminase (mean) (SD) | 107.9 (142.4) | | Alanine Transaminase (mean) (SD) | 142.4 (172.3) | | Lipase (mean) (SD) | 83.9 (261.3) | | Indication for ERCP | | Abnormal Labs | 637 (57%) | | Abnormal Imaging (CT, US or MRI) | 282 (25%) | | Malignancy | 32 (2.9%) | | Stent Management | 164 (15%) | | Sphincter of Oddi Dysfunction | 4 (0.4%) |
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