ERCP in critically ill patients is safe and does not increase mortality.

Area of Science:

• Gastroenterology
• Critical Care Medicine
• Interventional Endoscopy

Background:

• Endoscopic retrograde cholangiopancreatography (ERCP) is a standard minimally-invasive procedure for biliary and pancreatic diseases.
• Critically ill patients in intensive care units (ICUs) undergoing ERCP face higher morbidity risks compared to ambulatory patients.
• Limited data exists on the complications and outcomes of emergency ERCP in critically ill patients.

Purpose of the Study:

• To analyze the safety and outcomes of ERCP in critically ill patients admitted to ICUs.
• To evaluate the incidence of procedure-related complications and overall mortality in this patient cohort.
• To assess the efficacy of ERCP in managing biliary and pancreatic conditions in an ICU setting.

Main Methods:

• A retrospective analysis of 102 patients undergoing 121 ERCP procedures in ICUs between 2002 and 2016.
• Patient condition was assessed using the Simplified Acute Physiology Score (SAPS 3).
• Indications, interventional success rates, outcomes, survival, and complications were analyzed.

Main Results:

• ERCP procedures were highly successful (96.7%) with a low mortality rate during the procedure (1.0%).
• Common indications included post-liver transplant biliary complications (33.3%), biliary leakage (31.4%), and cholangitis/biliary sepsis (35.3%).
• Post-ERCP pancreatitis occurred in 11.8% of interventions; observed mortality (52.2%) aligned with predicted risk-adjusted mortality (48.8%).

Conclusions:

• ERCP is a safe and effective procedure for critically ill patients in the ICU.
• The procedure does not significantly increase the overall mortality rate in this population.
• ERCP is associated with a relatively low rate of procedure-related complications in ICU patients.