COMPARING OUTCOMES OF ERCP UNDER CONSCIOUS SEDATION TO GENERAL ANESTHESIA

Aims In Canada, ERCP performed under conscious sedation (CS) is the standard of care but is limited by patient movement and agitation, especially in the context of lengthy or technically complex cases. General anesthesia (GA) may optimize patient comfort and safety while reducing complications such as pancreatitis, perforation, and mortality. In October 2017, Kelowna General Hospital (KGH), in British Columbia, Canada, transitioned the standard anesthesia modality for ERCP from CS to GA. This study investigated differences in complications and patient outcomes for ERCP performed under CS (n=1334) before the practice change compared to GA (n=899) after the practice change.

Methods Our study is a pre-post retrospective chart review of 2,233 patients who underwent ERCP between 2015 and 2020 at KGH. Demographic, clinical, and procedural data were extracted from patient charts, and analyzed using univariate statistical analysis.

Results Rates of post-ERCP pancreatitis (6% vs. 4%; p=0.018) and rates of procedure failure (8% vs. 3%; p<0.001) were statistically significant and higher in the CS cohort compared to GS cohort. These results were significant despite the average Charlson Comorbidity Index Score, a measure of the number and severity of patient disease comorbidities, being higher in the GA cohort. The rates of 30-day mortality, ICU transfer, return rates post-discharge, and cholangitis were similar.

Conclusions Performing ERCP under GA rather than under CS is a valuable practice change that should be considered by ERCP-related programs due to its potential to reduce procedure failure and is associated with lower post-ERCP pancreatitis rates.

Publication History

Article published online:
14 April 2022