Outcomes of Endoscopic Retrograde Cholangiopancreatography (ERCP) for Choledocholithiasis in a Rural Australian...

Endoscopic retrograde cholangiopancreatography (ERCP) is an essential therapeutic modality for the management of pancreatobiliary disease. Only two prior studies have reported ERCP outcomes in the rural Australian healthcare context. This study aimed to evaluate a 5-year experience of therapeutic ERCP for choledocholithiasis at a major rural referral centre in western New South Wales (NSW).

A retrospective cohort study was conducted including all patients who underwent ERCP for suspected choledocholithiasis at a rural NSW referral centre between January 2020 and January 2025. Data were collected on patient demographics, clinical presentation, procedural characteristics, cannulation failure and 30-day morbidity and mortality.

Over the 5-year period, 1001 ERCP procedures were performed, of which 689 were for choledocholithiasis, treating 555 patients. Planned repeat ERCP for suspected incomplete duct clearance was required in 129 patients. Initial biliary cannulation failed in 11 patients, with successful repeat ERCP achieved in five within 72 h. Of the remaining six patients, one required percutaneous transhepatic cholangiography with anterograde stent placement, three had further intervention abandoned due to significant comorbidities and two were referred for SpyGlass cholangioscopy at a tertiary centre. Most procedures were performed emergently (81%) and 348 patients were transferred from peripheral hospitals. Median procedure time was 32 min and median length of stay was 2 days. ERCP-related complications occurred in 51 patients (9%), including post-ERCP pancreatitis (4%), post-sphincterotomy bleeding (3%), cholangitis (2%) and perforation (1%). Three ERCP-related deaths (0.4%) were recorded. Among emergency cases, median time to ERCP was shorter for local patients compared with transferred patients (1 vs. 4 days), with no difference in complication rates or 30-day mortality (p > 0.05).

This is one of the largest rural Australian ERCP series reported. Therapeutic ERCP for choledocholithiasis can be delivered safely and effectively in a rural setting, with outcomes comparable to tertiary centres.