Journal Article

P163 Reducing unnecessary ERCP for stone disease: is EUS the answer?

Ding, Michael, Prawiradiradja, Roderick, Hebbar, Srisha, Yau, Chia Chuin, Abbassi, Abdullah, Lam, Wai Liam

2024

Overview

IntroductionEndoscopic retrograde cholangiopancreatography (ERCP) should only be reserved for cases with appropriate indications, as it carries significant risks. Due to the risk of cholangitis, common bile duct (CBD) stones require extraction. However in practice there are usually delays between diagnostic imaging and intervention with ERCP. During this delay, stones can be passed spontaneously, rendering the need for ERCP obsolete. Endoscopic ultrasound (EUS) has been demonstrated to be accurate in diagnosing CBD stones. When spontaneous passage of stone is clinically suspected, EUS could be utilized in a single session immediately prior to intervention to confirm the necessity of intervention. We aim to study the reduction of unnecessary ERCP cases since the introduction of a single session EUS-ERCP in low risk stone cases in our unit.MethodsRetrospective data analysis was done on all ERCP in University Hospital North Midlands in the year 2015 and 2021 for stone disease. Clinically unnecessary ERCP cases were identified from this and defined as ERCP that revealed no stones or did not improve liver enzymes following the procedure. Comparison was made between the practice before (year 2015) and after (year 2021) the introduction of single session EUS-ERCP for low risk stone disease. Single session EUS-ERCP for stone disease were also analyzed for the number of cancelled ERCP due to normal EUS and number of cholangitis cases following cancellation.ResultsIn 2015, there was a total of 402 ERCP cases done for stone disease. 27 (6.7%) of these procedures were clinically unnecessary. In 2021, there was a total of 327 ERCP cases done for stone disease. 4 (1.2%) procedures were clinically unnecessary. There were 185 of single session EUS-ERCP for low risk cases, 92 (49.7%) had cancelled ERCP due to normal EUS. 3 patients (3.3%) were readmitted with cholangitis following cancellation of ERCP.ConclusionSingle session EUS-ERCP in low risk stone disease significantly reduced the rates of unnecessary ERCP. This allows for better allocation of resources in endoscopy for patients who needs intervention and reduces the risk of complications that patients would have otherwise been subjected to.

• Publisher: BMJ Publishing Group LTD
• Subject: Bile ducts / Cholangitis / Data analysis / Endoscopy