The Risk Of Endoscopic Retrograde Cholangiopancreatography (ERCP) Outside Core Working Hours. An Analysis Of The Austrian Ercp Benchmarking Survey

Aims Studies on the impact of the time of day on success and complication in endoscopic retrograde cholangiopancreatography (ERCP) are rare. In colonoscopy a reduced diagnostic and therapeutic yield already have been shown repeatedly at a later time of the day. In surgery and aviation, this topic is also well studied. We therefore aimed to evaluate the success and complication rate between ERCPs during (08:00 a.m. - 04:00 p.m.) and outside (04:00 p.m. - 08:00 a.m.) of core working hours.

Methods In this study, data from the nationwide ERCP benchmarking survey of the Austrian Society of Gastroenterology were studied with regard to success and complications in core working hours versus non-core working hours. Starting in 2013, this register provides insight into about 1/5 of all interventions performed in Austria per year. Indications for ERCP, comorbidities, severity (ASGE grading), type of sedation, achievement of treatment goal (success) and complications (AE; blood loss, post-ERCP pancreatitis/cholangitis, perforation, cardiopulmonary AEs) were reviewed and analyzed accordingly.

Results A total of 13901 ERCPs (95 % in core working hours) were included. A significantly higher rate of patients with gallstones, cholangitis and biliary pancreatitis were treated out of the core working hours (g: 45,8 vs. 66,9 %; c: 13,2 vs. 42,4 %; bp: 4,9 vs. 18 %). These patients showed more cardiopulmonary comorbidities, a higher rate of intubation and more cardiopulmonary complications (Table). Mortality did not differ significantly. ERCP severity (ASGE-grade III+IV) was higher in patients treated outside core hours (31,1 % core vs. 93,7 % non-core hours). Achievement of the therapeutic target showed no difference between the groups.

	core working hours	off core working hours	p - value
sedation (rate of intubation)	19,2 %	47,1 %	p < 0,001
achievement of the therapeutic target	86,3 %	89,0 %	n.s.
at least one complication	10,1 %	9,7 %	n.s.
cardio pulmonal complications	0,7 %	1,3 %	p < 0,05

Conclusions Patients outside core working hours showed a higher risk of cardiopulmonary complications. However, this is conceivable attributable to the higher rates of cardiopulmonary comorbidity and cholangitis. There was no difference in success and mortality between ERCPs during and outside core working hours.

Citation Steiner E, Duller C, Püspök A et al. eP133 THE RISK OF ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP) OUTSIDE CORE WORKING HOURS. AN ANALYSIS OF THE AUSTRIAN ERCP BENCHMARKING SURVEY. Endoscopy 2021; 53: S140.

Publication History

Article published online:
19 March 2021