Is Outpatient ERCP Safe for Choledocholithiasis?

• Published in: Meandros medical and dental journal 2022-04, Vol.23 (1), p.87-93
• Main Authors: Taşkıran, İsmail, Ödemiş, Bülent, Yıldız, Hakan, Parlak, Erkan
• Format: Article
• Language: English
• Subjects: Abdomen; Bile ducts; Cholangitis; Endoscopy; Gastroenterology; Hemorrhage; Pancreatitis; Patients; Statistical analysis
• ISSN: 2149-9063; 2149-9063
• DOI: 10.4274/meandros.galenos.2021.70370

Objective: This study aimed to compare the complications of outpatient and inpatient endoscopic retrograde cholangiopancreatography (ERCP) procedures in patients with bile duct stones and to investigate whether it is a safe approach to perform outpatient ERCP or not. Materials and Methods: This prospective study consisted of 203 patients who had undergone ERCP for the first time with a diagnosis of choledocholithiasis between January 2013-July 2013. Results: Of the patients included in the study, 102 had undergone outpatient and 101 had undergone inpatient ERCP. Complications following ERCP occurred in 9.8% of the outpatient group (pancreatitis in 5.9%, hemorrhage in 1.9%, cholangitis in 1%, perforation in 1%), while they occurred in the 11.9% of the inpatient group (pancreatitis in 6.9%, bleeding in 1%, cholangitis in 2%, perforation in 2%) (p=0.230, p=0.386, p=0.386, p=0.333, respectively; total complication comparison p=0.618). An amylase level below 150 U/L at the 4th hour after ERCP had a negative predictive value of 99.4% for pancreatitis to be negative. When the 4th hour amylase value of 300 U/L was taken as a limit, it had a positive predictive value of 52.1% in terms of pancreatitis positive. Additionally, the outpatient procedure was more cost-effective when the two groups were compared in terms of the cost [873.6±272.2 Turkish lira (TL) vs 1389.7±612.6 TL, p=0.001]. Conclusion: Our study demonstrated that outpatient ERCP was safe and costeffective in selected cases with bile duct stones. The 4th hour amylase level below 150 U/L after ERCP showed that patients can be safely sent home and that the amylase value above 3-fold at the 4th hour can be considered the limit value for admission to the hospital for pancreatitis.