Same-day discharge after endoscopic biliary sphincterotomy: observations from a prospective multicenter complication...

Area of Science:

• Gastroenterology
• Endoscopic Procedures
• Patient Safety

Background:

• Same-day discharge after endoscopic biliary sphincterotomy (ES) is a common practice.
• Limited data exist to guide patient selection for same-day discharge after ES.
• This study evaluated outcomes and identified risk factors for readmission after same-day ES discharge.

Purpose of the Study:

• To examine outcomes after same-day discharge following endoscopic biliary sphincterotomy (ES).
• To evaluate the ability of multivariate risk factor analysis to predict readmission for complications after ES.
• To identify predictors of complications in patients discharged on the same day as ES.

Main Methods:

• A prospective, multicenter database of 2347 patients undergoing ES was analyzed.
• Data on 150 variables were collected at the time of ES and at 30 days post-procedure.
• Complications were defined by consensus criteria and included adverse events requiring hospitalization.

Main Results:

• Of 614 patients discharged same-day, 35 (5.7%) were readmitted for complications.
• Patients with at least one risk factor (n=115) had a 12.2% readmission rate versus 4.2% for those without (n=499).
• Significant risk factors included suspected sphincter of Oddi dysfunction, cirrhosis, difficult cannulation, precut sphincterotomy, or combined procedures.

Conclusions:

• Same-day discharge after ES is widely used and relatively safe.
• A significant number of readmissions occur, particularly in high-risk patients.
• Observation for 6 hours or overnight may reduce readmissions for patients with identified risk factors.