Mawdsley, J.E.; Manoye, P.; Catterall, A.P.; McIntyre, P.; Greenfield, S.M.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA73
Academic Journal
Background: East and North Herts trust serves 500 000 patients; 350 ERCP procedures are performed/year. We present the largest UK prospective audit of 215 ERCPs. Methods: Data were collected using a standard proforma completed at the time of endoscopy (99% completion). Patients were phoned at 3 and 30 days, or discussed with their medical team if an inpatient, to assess for a procedure related complications. Results: Cannulation of the desired duct achieved at first attempt in 79% and 82% when the distal duodenum was reached. This improved to 85% with a repeat procedure. Biliary drainage was achieved in 64% of jaundiced patients (44/69). CBD stones were successfully removed in 71% at first procedures and 92% after a second procedure. Bile cytology was positive in (6/11) and bile brushings was positive in 32% (6/19). Findings: CBD normal (61), CBD stones (58), CBD dilation only (29), CBD stricture (29), duodenal obstruction (7), other (13). Procedures: Diagnostic (90), standard/needle knife sphincterotomies (50/17), stent insertion (27), CBD stone removal (53). Complication Rotes: Mild pancreatitis occurred in 3 cases (1.5%), Mild haemorrhage at the ampulla was reported in 7 (3.3%) but did not require admission or transfusion. Overnight observation was required in 4 patients (1.9%). Procedure related mortality occurred in 2 cases (0.9%); one patient with pancreatic cancer and liver metastases died from haemorrhage and the second from perforation of the duodenum due to peptic ulceration. Seven deaths (3.3%) occurred within the 30 day follow up period attributable to other causes. Conclusions: Complication rates were Iow and similar to other studies. Biliary cytology is worthwhile and more sensitive than brushings. Cannulation rates were similar to recommended JAG guidelines but drainage rates were lower and JAG recommendations may need to be reviewed. Pure diagnostic procedures were common and MRCP was used as a pre-procedure imaging modality in only 10%. This...


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