Updated guidance on the management of common bile duct stones (CBDS) published by the BSG at the start of 2017 highlighted the need for ready and prompt access to anaesthesia supported ERCP. Furthermore, it is commented that likelihood of therapeutic success is higher with anaesthetic support. Our unit has no formal provision for anaesthesia supported ERCP and as such this is currently performed on an ad hoc basis. Through analysis of our ERCP database since 2014 we demonstrate the benefits of anaesthesia supported ERCP and the need for a dedicated service.Methods
We performed a retrospective analysis of all patients who underwent ERCP in our unit from January 2014 to December 2017. The data was obtained from an excel database employed in our unit specifically for ERCP. We identified all procedures done under GA and recorded the indication for GA. We also identified procedures performed under conscious sedation where there was intention to repeat under GA. For all procedures in the study period we recorded whether the procedure was successful by intention. This permitted comparison of procedure success between conscious sedation and GA support. We were then able to further analyse the conscious sedation cases brought back for a repeat procedure under GA.Results
Over the study period 776 ERCPs were performed. 115 of these were done under GA (15%). The overall success by intention for all ERCPs was 80.5%. For those done under conscious sedation this was 79.6% whereas for those done under GA the overall success by intention was 83.5%. The indications for GA were: Intolerance of sedation (46%), complex procedure (17%), acutely unwell (11%), not documented (12%), patient decision (8%), other (6%).Results
In our sub analysis there were 77 cases (10% of total) that required at least one further procedure under GA having had the initial procedure under conscious sedation. 33 of these had failed by intention under conscious sedation. Under GA 73% of these cases were then successful.Conclusions
The analysis of our unit’s database is consistent with BSG guidance in that we demonstrated higher success rates with ERCPs done under GA. This effect is particularly highlighted in cases where ERCP failed under conscious sedation. We conclude that having ready access to anaesthetic support would undoubtedly reduce the need for repeat procedures. In addition we believe that provision of this service would generate significant financial savings to our trust in terms of day case tariffs as well as staff and equipment costs. Going forward, we are confident that this data will form the basis of a successful business case for anaesthesia supported ERCP in our hospital.