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[Endoscopic retrograde cholangiopancreatography can be performed safely in ambulatory centers]
Mara Virginia Lellis Marçal1, Fernanda Prata Borges Martins Thuler, Angelo Paulo Ferrari
1Disoplina de Gastroenterologia, Universidade Federal de São Paulo, Escola Paulista de Medicina-UNIFESP-EPM.
Background:
Endoscopic retrograde cholangiopancreatography is effective technique to approach various biliary and pancreatic disorders. Safety of endoscopic retrograde cholangiopancreatography on an outpatient basis has been questioned.
Objectives:
To evaluate the safety of outpatient endoscopic retrograde cholangiopancreatography and describe procedure complications.
Patients/Method:
We prospectively assessed outpatients endoscopic retrograde cholangiopancreatography during 2001 to 2003 period. Complications were defined according to consensus criteria and all adverse effects related to procedure were included.
Results:
One hundred and ninety five outpatients endoscopic retrograde cholangiopancreatography were performed, 79 (40.5%) diagnostic and 116 (59.5%) therapeutic. The study group included 112 women, mean age 51 (+/- 18.9) years. The most common diagnoses were: biliary calculi (30.2%), benign stenosis, (13.8%), malignant obstruction (10.2%) and chronic pancreatitis (10.2%). Success was achieved in 88.6% of diagnostic endoscopic retrograde cholangiopancreatography and 78.5% in therapeutic. Complications necessitating observation developed in 10 (5.1%) of 195 endoscopic retrograde cholangiopancreatography, among them, 7 (3.6%) were hospitalized, (2 acute pancreatitis, 2 perforations, 1 bleeding, 1 cardio-respiratory e 1 fever). Among 188 patients initially discharged 8 (4.2%) needed readmission (1 acute pancreatitis, 1 bleeding, 1 perforation, 3 cholangitis, 2 abdominal pain). Comparing the first group where complications were immediately identified to the second, no significant statistical difference concerning to age, sex, diagnoses and procedure difficulty degree was found.
Conclusion:
Sample size and negative statistical results failed to determinate independent risk factors for outpatients endoscopic retrograde cholangiopancreatography complications. However, there were no deaths or bad evolution in patients released after examination, confirming the safety of outpatient endoscopic retrograde cholangiopancreatography.
