10. Endoscopic
Retrograde
Cholangio-
pancreatography
INTRODUCTION
PATIENT PROFILE
THE PROCEDURE
THE ENDOSCOPIST
COMPLICATIONS AND DEATH
RECOMMENDATIONS
CHAPTER REFERENCES
n = number of cases where information was provided

 

THE PROCEDURE

Key point
Only 87% of patients had prophylactic antibiotics for their ERCP.

Of the 237 procedures, almost all involved the biliary tree (Table 42). These comprised of
two major groups, sphincterotomy (88) and stenting (216), of which 50 were preceded bya sphincterotomy.

Table 42. Type of procedure (answers may be multiple)
 
Total
n = 237
Sphincterotomy and removal of calculus
34
Sphincterotomy and insertion of stent
50
Sphincterotomy of accessory ampulla
4
Insertion of stents into both hepatic ducts
8
Insertion of stent into bile ducts
123
Renewal of stent in bile duct
19
Removal of stent from bile duct
15
Dilation of bile duct
8
Insertion of stent into pancreatic duct
1
Removal of calculus from pancreatic duct
1
Total
263

87% (195/224) of patients having a therapeutic ERCP received prophylactic antibiotics (Table 43).

Table 43. Antibiotic prophylaxis for ERCP
Antibiotic prophylaxis
Total
(%)
Yes
195
(87)
No
29
(13)
Sub-total
224
Not answered
13
(6)
Total
237

6% of patients undergoing ERCP without duct occlusion and 10% of those with duct occlusion are likely to develop bacteraemia9. In the BSG guidelines on the use of
antibiotics9, the BSG recommends antibiotic prophylaxis for all patients undergoing ERCP with evidence of biliary sepsis, pancreatic pseudo-cyst or previous cholangitis as well
as patients who are either at risk of infective endocarditis or are neutropenic. Antibiotic prophylaxis should more closely approach 100% in this high-risk group. Although there may be local protocols regarding antibiotic prophylaxis, it is the responsibility of the endoscopist to ensure the patient has received appropriate antibiotics before the procedure.

Table 44. Duration of ERCP procedures
Duration of procedure (minutes)
Total
(%)
0-10
1
(<1)
11-20
22
(18)
21-30
44
(36)
31-40
18
(15)
41-50
16
(13)
51-60
12
(10)
61-70
4
(3)
71-80
1
(<1)
81-90
2
(2)
91-100
2
(2)
>100
1
(<1)
Sub-total
123
Not answered
114
(48)
Total
237

One could anticipate that a therapeutic ERCP would take in the region of 45 minutes.
It is disappointing that for 48% (114/237) of cases the respondents were not able to provide times for the procedures; they should be available (Table 44). When times were provided 55% of procedures took under 30 minutes, 38% between 30 and 60 minutes and only 8% lasted for more than one hour. The procedure that lasted more than 100 minutes in fact lasted six hours!

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