Does out of Hours Endoscopic Retrograde Cholangiopancreatography Lead to Higher Pancreatitis and Hospitalization Rates?

BACKGROUND

Of endoscopic procedures, in which the skin is not breached, endoscopic retrograde cholangiopancreatography (ERCP) has by far the highest complication rate. The aim of this study was to determine if ERCP-related morbidity is even higher if performed out of working hours.

METHODS

Contemporaneously collected data of 3163 patients undergoing ERCP (213 out of hours and 2929 in hours).

RESULTS

Post-ERCP pancreatitis (PEP) occurred in 7 of 213 (3.3%) patients undergoing out of hours ERCP and 119 of 2929 (4.1%) patients undergoing in hours ERCP (p = 0.759). Average in hours procedure duration was 20 min, compared to 23 min in out of hours cases (p < 0.001). Fifty-one patients (23.9%) in the out of hours group had a prior sphincterotomy compared with 1148 (39.2%) in hours patients (p < 0.001). Eighty-seven (40.8%) out of hours patients had their procedure performed for cholangitis compared with 232 (7.9%) in hours patients (p < 0.005). Twenty-five out of hours patients (11.7%) had ERCP performed for bile leak, compared with 49 (1.7%) in hours patients (p < 0.005). Prolonged procedure duration in the out of hours procedures remained significant with multivariate analysis.

CONCLUSIONS

To the extent that there was no difference in the rate of PEP nor unplanned hospitalisation between out of hours and in-hours cases, no evidence for increased risk of out of hours procedures was found. Out of hours ERCPs were of longer duration compared with in-hours cases possibly due to delays related to reduced staffing and impaired logistics, rather than factors likely to increase PEP such as a higher number of cannulation attempts.