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Abstract
Objectives This analysis assessed current endoscopic retrograde cholangiopancreatography (ERCP) practice within the UK, including use of sedation and patient comfort.
Methods ERCPs conducted over 1 year (1 July 2021–30 June 2022) and uploaded to the National Endoscopy Database (NED) were analysed. The endoscopist workforce was classified by gender and specialty, use of sedation was analysed. Logistic regression was used to assess associations between patient age, gender and procedure indications on moderate to severe discomfort risk.
Results 27 812 ERCPs were performed by 491 endoscopists in 175 sites and uploaded to NED, an estimated 50% of total UK activity. 13% were training procedures, 94% of the endoscopists were male, with 72% being gastroenterologists. Most ERCPs were performed under conscious sedation (89%). The discomfort rate among patients aged 60–90 undergoing ERCP under conscious sedation was 4.2% (95% CI 3.9% to 4.5%), with only 5.5% (95% CI 5.2% to 5.9%) receiving greater than 5 mg midazolam or 100 µg fentanyl.
Younger patients (<30 years) had a higher discomfort risk during conscious sedation ERCPs than those aged 70–79 (OR 3.0, 95% CI 2.2 to 4.3, p<0.05), while male patients had a lower discomfort risk compared with females (OR 0.9, 95% CI 0.8 to 1.0, p=0.05).
Enhanced sedation (propofol or general anaesthetic) was associated with lower frequency of discomfort (0.3%, 95% CI 0.1 to 0.6) compared with conscious sedation (5.1%, 95% CI 4.9% to 5.4%, p<0.05).
Conclusions Conscious sedation is well tolerated for most patients and prescribing practices have improved. However, triage of more patients, particularly young females, to enhanced sedation lists should be considered to reduce discomfort rates in future.
- CLINICAL DECISION MAKING
- DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY
- ENDOSCOPIC PROCEDURES
- TOLERANCE
- ENDOSCOPIC RETROGRADE PANCREATOGRAPHY
Data availability statement
Data are available on reasonable request.
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- CLINICAL DECISION MAKING
- DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY
- ENDOSCOPIC PROCEDURES
- TOLERANCE
- ENDOSCOPIC RETROGRADE PANCREATOGRAPHY
Data availability statement
Data are available on reasonable request.
Footnotes
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Contributors DB, LS, MR and VM designed the study. DB analysed the data and is the guarantor. DB and BA drafted the manuscript, which was revised with input from MR, LS, SME, KWO and VM. All authors approved the manuscript for submission.
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 LS has unrestricted project grants from Medtronic and 3D Matrix. No other competing interests declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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