Abstract
Background and study aims Critically ill patients may require endoscopic retrograde cholangiopancreatography
(ERCP) but performing ERCP in the intensive care unit (ICU) poses logistic and technical
challenges. There are no data on ICU patients undergoing ERCP in the endoscopy suite.
The primary aim of this study was to report outcomes, including safety, when ERCP
in critically ill patients is performed in the endoscopy suite.
Patients and methods We queried our institutional endoscopy database to identify all ICU patients who underwent
ERCP at a single academic medical center from 04/01/2010 to 11/30/2017. Only patients
admitted to an ICU prior to ERCP were included.
Results Of 7,218 ERCPs performed during the study period, 260 ERCPs (3.6 %) were performed
in 231 ICU patients (mean age 61y; 53 % male); nearly all ICU patient ERCPs (n = 258;
99 %) occurred in the endoscopy suite. ERCP indications included cholangitis (50 %),
post-liver transplant cholestasis (15 %), and bile leak (10 %). All ERCPs were performed
with anesthesiology, most with general anesthesia (60 %) and in the prone position
(60 %). Most patients (73 %) had sepsis. Prior to ERCP, 17 % of patients required
vasopressors; vasopressors were begun during ERCP in 4 %.
The cannulation success rate was 95 % (94 % in native papillae). Adverse events occurred
in 9 % (n = 23) of cases with post-ERCP pancreatitis most common. No patients died
during or within 24 hours of ERCP. Mortality at 30 days was 16 %, all attributed to
underlying disease.
Conclusions When advanced ventilatory and hemodynamic support is available, critically ill patients
can safely and effectively undergo ERCP in the endoscopy suite.
