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Does out of Hours Endoscopic Retrograde Cholangiopancreatography Lead to Higher Pancreatitis and Hospitalization
Hasib Ahmadzai1, Youngjun Ban2, Wilson Siu1
1Gastroenterology & Hepatology Unit, The Canberra Hospital, ACT Health, Canberra, Australia.
Background:
Of endoscopic procedures, in which the skin is not breached, endoscopic retrograde cholangiopancreatography (ERCP) has by far the highest complication rate. The aim of this study was to determine if ERCP-related morbidity is even higher if performed out of working hours.
Methods:
Contemporaneously collected data of 3163 patients undergoing ERCP (213 out of hours and 2929 in hours).
Results:
Post-ERCP pancreatitis (PEP) occurred in 7 of 213 (3.3%) patients undergoing out of hours ERCP and 119 of 2929 (4.1%) patients undergoing in hours ERCP (p = 0.759). Average in hours procedure duration was 20 min, compared to 23 min in out of hours cases (p < 0.001). Fifty-one patients (23.9%) in the out of hours group had a prior sphincterotomy compared with 1148 (39.2%) in hours patients (p < 0.001). Eighty-seven (40.8%) out of hours patients had their procedure performed for cholangitis compared with 232 (7.9%) in hours patients (p < 0.005). Twenty-five out of hours patients (11.7%) had ERCP performed for bile leak, compared with 49 (1.7%) in hours patients (p < 0.005). Prolonged procedure duration in the out of hours procedures remained significant with multivariate analysis.
Conclusions:
To the extent that there was no difference in the rate of PEP nor unplanned hospitalisation between out of hours and in-hours cases, no evidence for increased risk of out of hours procedures was found. Out of hours ERCPs were of longer duration compared with in-hours cases possibly due to delays related to reduced staffing and impaired logistics, rather than factors likely to increase PEP such as a higher number of cannulation attempts.
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