THE SAFETY OF DIAGNOSTIC AND THERAPEUTIC ERCP AS A DAYCASE PROCEDURE WITH A SELECTIVE ADMISSION POLICY

Objective: To assess if therapeutic endoscopic retrograde cholangiopan creatography (ERCP) as a daycase procedure with a selective admission policy is safe and cost-effective. Design: An audit of case notes of p atients who attended as a daycase for either a therapeutic or diagnost ic ERCP over a 20-month period. Setting: Stoke-on-Trent District Gener al Hospital. Patients: Case notes of all patients who had an ERCP as a daycase were audited. Interventions: Therapeutic procedures performed as daycases included papillotomy, stent insertion, balloon dilatation or a combination of these procedures. Patients are discharged home 2 h after diagnostic or therapeutic ERCP. Main outcome measures: Thirty- day morbidity and mortality of daycase patients.Results: During the 20 -month period audited, 550 ERCPs were performed, of which 240 attended initially as daycases. There were 97 successful daycase therapeutic E RCPs. Ten patients were admitted immediately after ERCP including one who subsequently died from a myocardial infarction (known severe ischa emic heart disease); 87 patients were discharged 2 h after ERCP; none were admitted between 2 and 48 h after ERCP; 4 were admitted between 4 8 h and 30 days after ERCP with complications. There were 117 successf ul daycase diagnostic ERCPs; 4 patients were admitted immediately due to frailty, 4 were admitted between 2 and 48 h and 1 at 28 days after ERCP with complications. There were 24 failed diagnostic and 2 failed therapeutic ERCPs. Conclusion: Daycase ERCP with a selective admission policy is safe and cost-effective.