ERCP in critically ill patients unit is a safe procedure and does not increase mortality

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is an important intervention in the management of biliopancreatic disease. Although there is a well-defined spectrum of complications, the procedure itself is considered to be safe in most patients. However, data on critically ill patients treated in intensive care unit (ICU) who undergo emergency ERCP are limited with regard to outcome and complication rate

Patients and methods: A retrospective analysis was performed of 102 patients treated in intensive care undergoing a total of 121 ERCP between 2002 and 2016 at the University Hospital Essen. Indications, interventional success rates, survival, outcome and ERCP-related complications were analyzed. Patients' condition pre-ERCP was categorized by using the “Simplified Acute Physiology Score” (SAPS) 3 score, thus predicting in-hospital mortality.

Results: 76 of 102 patients (74.5%) with an average SAPS 3 score of 67.5 (translating into a calculated probability of in-hospital mortality of 50%) were referred to ERCP from surgical intensive care units, the remaining 26 (25.5%) were treated for non-surgical disease ICU. The majority of patients were males (63.7%), the mean age was 54.1 [21 – 87] years. The indications for ERCP were: biliary leakage after major liver surgery (44.6%), cholestasis/cholangitis (38.0%), cholangiopathy after liver transplant (15.7%) and bleeding after prior ERCP (1.7%). The intervention was successfully performed in 92.6%. One patient (0.8%) died from septic shock during the procedure. Post-ERCP pancreatitis occured in 16.2%. The mortality of all patients was 52.2% (compared to a predicted mortality of 50%).

Conclusions: ERCP is safe in critically ill patients treated on ICU without increasing procedure-associated complications compared to non-critical patients. The procedure itself does not increase mortality in this challenging group of patients.