Introduction
Early discharge post ERCP can potentially reduce strain on the tight bed occupancy status in tertiary hospitals.
Aims & Methods
The aim of this study is to evaluate the safety of early discharge (<24 hours) for patients who had undergone ERCP in a tertiary hospital in Singapore.
This is a retrospective observational study which reviewed patients who were admitted in the TTSH Medical Ambulatory Center (MAC) and discharged within 16 hours post ERCP. To assess safety of this service, electronic medical records of patients admitted between January 2022 and February 2024 were reviewed. Complications post ERCP, predisposing factors, patient demographics were reviewed.
Results
There were 400 patients admitted to MAC for early discharge after ERCP during this period. The overall complication rate was 5.8% (23 patients). Post-ERCP pancreatitis was diagnosed in 1.8% (7 patients) of the admissions, whereas those who developed post-ERCP cholangitis accounted for 3.5% (14 patients). 1 patient developed non-specific chills with no fever nor abdominal pain (not conclusive for either cholangitis or pancreatitis) 2 days post discharge from MAC. 1 patient had post ERCP cholangiopancreatitis (0.3%). No other patients presented with complications related to ERCP after discharge.
Out of the 23 patients with post ERCP complications, 5 (21.7%) patients developed within 1-6 hours (3 pancreatitis, 2 cholangitis). 8 (34.8%) patients (3 pancreatitis, 5 cholangitis) developed within 7-11 hours, whereas 8 (34.8%) patients (1 pancreatitis,7 cholangitis) developed within 12-16 hours post ERCP. 1 patient with cholangiopancreatitis presented within 6 hours.
Of the 14 patients with post ERCP cholangitis, 7 were females and 7 were males. The median age (years) for this group was 72,youngest being 32 and eldest 80. 6 patients in this group had undergone a concurrent spyglass cholangioscopy during ERCP. All of them received prophylactic antibiotics prior to cholangioscopy. It was also noted that there were 6 patients in this group of post ERCP cholangitis with Diabetes Mellitus
Out of 7 patients with post ERCP pancreatitis, 6 were females and 1 was male. The median age (years) for this group was 72, youngest being 56 and eldest being 85. All but 1 patient in this group had sphincterotomy performed. All patients in this group received 100 milligrams of rectal diclofenac for prophylactically. Only 1 patient had documented difficult cannulation.
| Post ERCP Cholangitis
| Post ERCP Pancreatitis
| Post ERCP Cholangiopancreatitis
| Others
|
| Number | 14 | 7 | 1 | 1 |
| Age (years) | Median:72 Youngest: 32 Oldest: 80 | Median:72 Youngest: 56 Oldest: 85
| 63 | 74 |
| Gender distribution | Male: 7 Female: 7 | Male: 1 Female: 6
| Female: 1 | Male: 1 |
Risk factors
| Diabetes Mellitus, Concurrent cholangioscopy, Complex pancreatico-biliary anatomy | Complex pancreatico-biliary anatomy, Female gender, Difficult cannulation
| Complex pancreatico-biliary anatomy
| Not Applicable |
Onset post ERCP (hours)
1-6
7-11
12-16 | 2
5
7
| 3
3
1 | 5 hours (1 patient) | unclear |
Conclusion
From this study, it could be concluded that it was safe to allow early discharge for patients who had undergone ERCP, if there is a clear monitoring protocol and discharge plans. The onset of post ERCP pancreatitis tend to be earlier compared to those who developed post ERCP cholangitis. There is female predominance in the post ERCP pancreatitis group. The patients who develop post ERCP pancreatitis tend to be older. Complex pancreatico-biliary anatomy is a significant risk for post ERCP complications. As there were 94.2% of the patients who remained well after ERCP, they could be potentially discharged even earlier (<10 hours). Further research could focus on early identification of patients who are likely going to develop post ERCP complications to facilitate early discharge, thus relieving tight bed occupancy status.
References
Hui, C., Lai, K. C., Wong, W., Yuen, M., Ng, M., Chan, C., Hu, W., Cheung, W., Lai, C., amp; Wong, B. C. (2004). Outpatients undergoing therapeutic endoscopic retrograde cholangiopancreatography: Six-hour versus overnight observation. Journal of Gastroenterology and Hepatology, 19(10), 1163–1168
Jeurnink, S. M., Siersema, P. D., Steyerberg, E. W., Dees, J., Poley, J., Haringsma, J., amp; Kuipers, E. J. (2011). Predictors of complications after endoscopic retrograde cholangiopancreatography: a prognostic model for early discharge. Surgical Endoscopy and Other Interventional Techniques, 25(9), 2892–2900.
Disclosure
There is no conflict of interest to declare