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Updated: May 23, 2026
Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
Biliary endoscopic drainage of septic ICU patients deemed emergent (BEDSIDE): a retrospective cohort study
Vibhu Chittajallu1, Abbinaya Elangovan2, Yazan Abu Omar3
1Digestive Health Institute, University Hospitals, Cleveland, OH, 44106, USA. vibhuc7@gmail.com.
Insights
Biliary Endoscopic Drainage of Septic ICU patients Deemed Emergent (BEDSIDE) ERCP offers feasible, expedited biliary drainage for critically ill patients with severe acute cholangitis when conventional ERCP is unavailable. This technique shows promise in reducing mortality in urgent situations.
Area of Science:
- Gastroenterology
- Critical Care Medicine
- Interventional Endoscopy
Background:
- Severe acute cholangitis mortality is reduced by biliary drainage.
- Conventional ERCP can be delayed for critically ill ICU patients.
- Timely drainage is crucial for severe acute cholangitis outcomes.
Purpose of the Study:
- To describe the Biliary Endoscopic Drainage of Septic ICU patients Deemed Emergent (BEDSIDE) ERCP technique.
- To assess the feasibility of BEDSIDE ERCP for expedited biliary drainage.
- To evaluate BEDSIDE ERCP in critically ill patients with severe acute cholangitis when conventional ERCP is unavailable.
Main Methods:
- Retrospective cohort study (2012-2022) at a tertiary care hospital system.
- Analysis of patients undergoing BEDSIDE ERCP for acute cholangitis.
- Data collection included demographics, hospital course, and endoscopic findings.
Main Results:
- 14 patients underwent BEDSIDE ERCP; all were critically ill (100% SIRS, 79% vasopressors, 43% mechanical ventilation).
- Successful biliary stent placement occurred in 79% of cases (11/14).
- 30-day cholangitis-related mortality was 14%.
Conclusions:
- BEDSIDE ERCP is a feasible approach for expedited biliary drainage in ICU patients.
- This technique is indicated in rare circumstances where timely conventional ERCP is unavailable.
- BEDSIDE ERCP can negatively affect clinical outcomes if further delayed biliary drainage is required.
Background:
Mortality for severe acute cholangitis is significantly reduced after endoscopic biliary drainage. Our institution has utilized endoscopic retrograde cholangiopancreatography (ERCP) without fluoroscopy in the intensive care unit (ICU), termed Biliary Endoscopic Drainage of Septic ICU patients Deemed Emergent (BEDSIDE) ERCP, in rare circumstances for critically ill patients with severe acute cholangitis where timely conventional ERCP was not available and delayed biliary drainage could adversely affect clinical outcomes. The objective of this study is to describe the BEDSIDE technique and its feasibility to provide expedited biliary drainage in critically ill patients in the ICU with severe acute cholangitis where timely conventional ERCP was not available.
Methods:
We performed a retrospective cohort study from 2012 to 2022 at our tertiary care hospital system of patients who underwent BEDSIDE ERCP for acute cholangitis. Data collection included demographics, hospital course, and endoscopic findings.
Results:
We identified 14 patients who underwent BEDSIDE ERCPs. Identified patients were critically ill with high incidences of vasopressor requirements (79%), mechanical ventilation (43%), and systemic inflammatory response syndrome (SIRS) (100%). Median time from admission to ERCP was 13.6 h (range 9.3-18.5 h). BEDSIDE approach had successful biliary stent placement in 11 patients (79%), including all 5 patients with prior biliary sphincterotomies. 30-day cholangitis-related mortality was 14%.
Conclusion:
BEDSIDE ERCP is proposed as a feasible approach to expedited biliary drainage for critically ill patients in the ICU with severe acute cholangitis in the rare circumstances that timely conventional ERCP with fluoroscopy is unavailable and further delayed biliary drainage could negatively affect clinical outcomes.
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