PATIENT PROFILE

Of all patients having an ERCP 82% (194/237) were aged 70 years or older (Figure 14) and 49% were male.

Figure 14. Age profile of patients undergoing ERCP

Of all patients having an ERCP 77% (173/224) were graded ASA3 or poorer (Table 38). Interestingly 16 were graded 5, but no specific details were available to the advisors to enable them to assess whether a therapeutic ERCP was appropriate.

Considering the data in Table 38, it is not surprising that patients had the co-morbid conditions as listed in Table 39.

From the data available 65% (153/234) of ERCPs were 'expected' procedures (Table 40).
The advisors thought that approximately one third of patients having an urgent/emergency ERCP was appropriate, and that in their experience the commonest causes were biliary sepsis especially from an obstructed common bile duct, bile leaks e.g. post laparoscopic cholecystectomy and gall stone related pancreatitis.

In 69% (155/224) of cases, death within 30 days of the procedure was thought to be a definite risk or expected (Table 41). This reflects that in these patients ERCP was often palliative where the patient had a malignant disease. Overall the patient profile indicates
that mostly these were sick patients of advanced age. Of interest is the advisors view that 68% (162/237) of therapeutic ERCPs were futile, with 90% (146/162) of these patients having an ASA status of 3 or more. The advisors were concerned that patients with
hepatic metastases and no biliary obstruction were having therapeutic ERCPs.