Patient Safety and Care After Outpatient Endoscopic Retrograde Cholangiopancreatography (ERCP): A Single-Center Experience in Germany

Abstract

Background

The current goal of adapting care structures in the German healthcare system is to increase the provision of interventional treatments in outpatient settings. Endoscopic Retrograde Cholangiopancreatography (ERCP) procedures were traditionally performed in an inpatient setting until 2022. However, with the introduction of a new Ambulatory Surgery Contract (according to Section 115b, Paragraph 1 of the Social Code, Book V) on January 1, 2023, these procedures are now intended to be carried out more strictly on an outpatient basis, meaning that hospitalization will no longer be reimbursed in most cases.

Methods

Between June 1, 2023, and December 31, 2023 all ERCP procedures performed in an outpatient setting were included in this study. This cohort had standard ERCP indications and a low comorbidity burden according to the §115b specifications. Using propensity score matching (nearest-neighbor), these cases were matched with patients who underwent ERCP procedures in an inpatient setting between June 1, 2022, and December 31, 2022.

Results

Propensity-score matching identified a cohort of 166 patients (83 outpatients and 83 inpatients) with similar baseline characteristics. The most common indications for ERCP were choledocholithiasis and biliary strictures. Reported complications comprised pancreatitis, bleeding and cholangitis and were rare in both groups, occurring in 7% of inpatient procedures and in 6% of outpatient procedures. The latter cases required inpatient admission after self-presenting to the emergency department. No serious adverse events were reported.

Conclusions

Outpatient ERCP is a safe procedure for selected patients with a low risk profile. Complications occurred rarely and could be adequately managed.

Zusammenfassung

Hintergrund

Ziel der aktuellen Anpassung von Versorgungsstrukturen im deutschen Gesundheitssystem ist es, die Durchführung interventioneller Behandlungen im ambulanten Bereich zu fördern. Bis 2022 wurden endoskopisch-retrograde Cholangiopankreatografien (ERCP) traditionell stationär durchgeführt. Mit der Einführung eines neuen Vertrages zur ambulanten Operation (gemäß §115b Abs. 1 SGB V) zum 1. Januar 2023 sollen diese Eingriffe nun überwiegend ambulant erfolgen, wodurch eine stationäre Abrechnung in den meisten Fällen nicht mehr möglich ist.

Methoden

Zwischen dem 1. Juni 2023 und dem 31. Dezember 2023 wurden alle ambulant durchgeführten ERCP-Verfahren in diese Studie einbezogen. Die eingeschlossenen Patienten wiesen Standardindikationen für eine ERCP und eine geringe Komorbiditätsbelastung gemäß den §115b-Kriterien auf. Mittels Propensity-Score-Matching wurden diese Fälle mit stationären ERCP-Patienten aus dem Zeitraum vom 1. Juni 2022 bis zum 31. Dezember 2022 gematched.

Ergebnisse

Durch das Propensity-Score-Matching wurde eine Kohorte von 166 Patienten (83 ambulante und 83 stationäre Patienten) mit vergleichbaren Ausgangsmerkmalen identifiziert. Die häufigsten Indikationen für ERCP waren Choledocholithiasis und biliäre Strikturen. Komplikationen, darunter Pankreatitis, Blutungen und Cholangitis, traten in beiden Gruppen selten auf (7% stationär vs. 6% ambulant). Bei den ambulanten Fällen führten Komplikationen in einigen Fällen zu einer stationären Aufnahme nach Selbstvorstellung in der Notaufnahme. Schwerwiegende unerwünschte Ereignisse wurden nicht berichtet.

Schlussfolgerung

Die ambulante Durchführung einer ERCP ist bei sorgfältig ausgewählten Patienten mit niedrigem Risikoprofil sicher. Komplikationen traten selten auf und konnten adäquat behandelt werden.

Keywords

ERCP - Endoscopy - bile duct

Schlüsselwörter

ERCP - Endoskopie - Leber

Publikationsverlauf

Eingereicht: 21. November 2024

Angenommen: 20. Februar 2025

Artikel online veröffentlicht:
31. März 2025

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