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Research
Day case ‘treat and transfer’ ERCP service under general anaesthesia
  1. Yasser El-Sherif1,2,
  2. John Hunt1,
  3. Abid Suddle1,
  4. Brian Prater3,
  5. David Reffitt1,
  6. John Devlin1,
  7. Phillip Harrison1,
  8. Deepak Joshi1
  1. 1Institute of Liver Studies, King’s College Hospital, London, UK
  2. 2National Liver Institute, Menoufia University, Shebin El-Kom, Egypt
  3. 3Department of Anaesthetics, King’s College Hospital, London, UK
  1. Correspondence to Dr Yasser El-Sherif, Institute of Liver Studies, King’s College Hospital NHS Foundation Trust, London SE59RS, UK; y.el-sherif{at}nhs.net

Abstract

Objective General anaesthesia (GA) has been increasingly used for advanced endoscopic procedures in particular endoscopic retrograde cholangiopancreatography (ERCP). Given the increasing pressure on many hospitals, the delivery of such service on a regular basis may not always be possible. We established a new day case ‘GA ERCP’ service. We describe our experience in evaluating the safety and overall feasibility of this new service.

Design Prospective database has been interrogated for the period from March 2015 to December 2016. We documented patients’ demographics, ERCP indications, American Society of Anesthesiologists (ASA) status, Cotton grade and complications.

Results 67 patients were referred to endoscopy unit at King’s College Hospital (KCH), for urgent day case GA ERCP from nine referring hospitals. The main indications were failed ERCP under sedation 47.8% (32/67), and unavailability of ERCP locally 41.8% (28/67). A total of 64 patients were actually transferred to KCH; 57.8% (37/64) women with a median age 55.8 years (range 23–90). 78.1% (50/64) of patients had a virgin papilla, with 39% (25/64) were ASA ≥3. The Cotton grade was ≥ 3 in 50% (32/64) patients. ERCP was completed successfully in 87.5% (56/64). For patients with previous failed ERCP, repeat ERCP under GA was successful in 75% (24/32). All patients were safely discharged back to their referring hospitals after the short observation period post-ERCP.

Conclusions Urgent inpatient transfers between hospitals for performing ERCP under GA as a day case is safe and feasible. The new GA ERCP pathway can be replicated by other UK centres.

  • endoscopic retrograde pancreatography
  • health service research
  • biliary endoscopy

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Footnotes

  • Contributors YES and DJ assisted with the acquisition, analysis and interpretation of the data; wrote, edited and revised the article. JH, AS, BP, DR, JD and PH helped edit and revise the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Presented at This abstract has been published in GUT prior to submitting this manuscript.

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