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P244 Combined EUS and ERCP experience in a district general hospital: can it be achieved safely?
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P244 Combined EUS and ERCP experience in a district general hospital: can it be achieved safely?
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Journal Article
P244 Combined EUS and ERCP experience in a district general hospital: can it be achieved safely?
2024
Overview
AimsCombined EUS/ERCP is a practice which offers an opportunity to diagnose and treat biliary pathology within the same sitting.It can avoid unnecessary ERCP and the subsequent complications associated with that procedure. This practice is increasingly performed in tertiary care centres but data is lacking for its safety and success rate in District General Hospitals. Access to deep sedation is restricted in many endoscopy units in the UK. The aim of this study was to evaluate the safety and procedure outcomes of this practice against ERCP alone in a District General Hospital setting.MethodsRetrospective analysis of data was performed for patients who had combined EUS/ERCP versus ERCP alone from April 2020 to April 2023. We evaluated the following: demographics, median sedation dosages, success of biliary cannulation, completion and complication rates.ResultsCombined EUS/ERCP group had 66 patients, 65 cases had conscious sedation and one had Propofol. 55 had stone disease and 11 had strictures. In the same period, 690 ERCP were performed as stand alone procedures, 682 cases had conscious sedation and 8 had Propofol. Group differences were tested with the chi square test and the Student’s t test at a significance level of p<0.05.Abstract P244 Table 1 Combined EUS/ERCP ERCP alone Statistical difference Demographics 27M : 39F Mean Age: 65 301M : 389F Mean Age: 69 NS Biliary cannulation (first ever ERCP) 60/66 (91%) 538/568 (95%) NS Biliary completion rate (stone extraction/stent placement) 60/66 (91%) 407/472 (86%) NS Complications (all procedures) 5/66 (7.75%) 42/690 (6.08%) NS Median Midazolam 5.8 mg (Range 2.5mg - 8mg) 3.4 mg (Range 1 - 9mg) p<0.01 Median Fentanyl 136.1mg (Range 50 - 200mg) 85.3mg (Range 25 - 200mg) p<0.01 ConclusionIn our clinical practice, combined EUS/ERCP had comparative procedural outcomes to stand alone ERCP. However, to achieve these outcomes we needed to use significantly increased incremental dosages of sedation. A recent BSG guideline has advised that combined EUS/ERCP should be considered to be performed under deep sedation. Our experience supports this advice and highlights the increasing need for anaesthetic support within UK endoscopy units.
