EMERGENCY ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY IN CRITICALLY ILL PATIENTS

Background: The aim of this study was to assess the frequency, indicat ions, yield, and outcome of emergency endoscopic retrograde cholangiop ancreatography (ERCP) in critically ill patients. Methods: Records of all intensive care unit patients undergoing emergency ERCP were review ed over a 40-month period. Indications, findings, therapeutic interven tions, and survival were analyzed. Those requiring mechanical ventilat ion at the time of ERCP were in group A and those who did not were in group B. Results: Of 1781 ERCPs, 32 (1.80%) were performed on intensiv e care unit patients. Fifteen patients belonged to group A (46.87%) an d 17 (53.13%) to group B. The common bile duct was the duct of interes t in 30 patients (94%) and was cannulated in 97%. Indications included possible biliary sepsis (68.75%), gallstone pancreatitis, and jaundic e (12.5% each). The most common finding was choledocholithiasis (34%), followed by failure to fill the cystic duct (16%) and common bile duc t stricture (9%). A normal examination was present in 18.75% of cases. Endoscopic therapy was required in 66.6% of patients in group A and 7 0.5% of group B. The overall 30-day mortality was 25% (33% for group A and 17.6% for group B) and not related to the ERCP. Conclusions: Two percent of all ERCPs performed were on intensive care unit patients (4 7% requiring mechanical ventilation) primarily to evaluate for possibl e biliary sepsis. Technical success was not compromised by mechanical ventilation. Therapeutic intervention was required in more than two th irds of patients and the overall 30-day mortality was 25%.