RT Journal Article
SR Electronic
T1 Day case ‘treat and transfer’ ERCP service under general anaesthesia
JF Frontline Gastroenterology
JO Frontline Gastroenterol
FD BMJ Publishing Group Ltd
SP flgastro-2017-100880
DO 10.1136/flgastro-2017-100880
A1 Yasser El-Sherif
A1 John Hunt
A1 Abid Suddle
A1 Brian Prater
A1 David Reffitt
A1 John Devlin
A1 Phillip Harrison
A1 Deepak Joshi
YR 2018
UL http://fg.bmj.com/content/early/2018/03/09/flgastro-2017-100880.abstract
AB 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.