OUTPATIENT THERAPEUTIC ERCP - A SERIES OF 262 CONSECUTIVE CASES

Background: Because of possible complications, it has been common prac tice to admit most if not all patients undergoing therapeutic ERCP. Th erefore, little descriptive data exist on the safety of outpatient the rapeutic ERCP. Methods: We assessed 262 consecutive ERCPs in 209 patie nts undergoing outpatient therapeutic ERCP lover a 5-year period, with particular attention to the development of complications. All outpati ent endoscopic sphincterotomies and stent placements performed over a 5-year period were prospectively entered into an ongoing data base tha t was used for the analysis. In addition, hospital and office records for all patients were retrospectively reviewed, including a 30 to 45 d ay follow-up in a private office setting. Results: Suspected or docume nted choledocholithiasis was the most common indication for ERCP and w as present in 132 (50%), followed by malignant obstruction in 77 (29%) , type I sphincter of Oddi dysfunction (on the basis of symptoms, live r test abnormalities, and bile duct dilatation) in 36 (14%), chronic p ancreatitis in 10 (3.8%), HIV cholangiopathy in 4 (1.5%), and other co nditions in 3 (1.1%). Overall, 181 patients (69%) underwent a sphincte rotomy. The 30-day post-ERCP complication rate was 5.7% (95% CI: 3.2% to 9.3%), occurring in 15 of 262 cases. Complications necessitating ho spitalization developed in 9 of the 262 ERCPs for a rate of 3.4% (95% CI: 1.6% to 6.4%). The mean duration of hospital stay among patients a dmitted for a complication was 2.7 +/- 1.8 days (range, 1 to 7 days). All patients were discharged without permanent sequelae. No 30-day pro cedure-related fatalities were reported. Conclusion: In this selected series of 262 consecutive cases, endoscopic sphincterotomy and stent p lacement were safely performed in an ambulatory setting. Prior to reco mmending a generalized change in existing practice, however, this find ing requires validation with larger series of cases, including the per formance of other outpatient therapeutic ERCP techniques.