Endoscopic Retrograde Cholangiopancreatography Under General Anesthesia Compared to Conscious Sedation Study

Abstract Background Endoscopic retrograde cholangiopancreatography (ERCP) is used to diagnose and treat pancreatic and biliary disease. The current standard is to conduct ERCP under conscious sedation (CS). Patient movement and agitation during ERCP under CS can result in procedure failure and compl...

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Veröffentlicht in:Journal of the Canadian Association of Gastroenterology 2024-04, Vol.7 (2), p.154-159
Hauptverfasser: Greaves, Grant, Harding, Kaitlyn G, Parker, Brent, Nguyen, Vu C, Ahmed, Azim, Yee, Belinda, Perren, Joël, Norman, Mathew, Grey, Morgan, Perini, Rafael, Jowhari, Fahd, Bak, Adrian
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container_issue 2
container_start_page 154
container_title Journal of the Canadian Association of Gastroenterology
container_volume 7
creator Greaves, Grant
Harding, Kaitlyn G
Parker, Brent
Nguyen, Vu C
Ahmed, Azim
Yee, Belinda
Perren, Joël
Norman, Mathew
Grey, Morgan
Perini, Rafael
Jowhari, Fahd
Bak, Adrian
description Abstract Background Endoscopic retrograde cholangiopancreatography (ERCP) is used to diagnose and treat pancreatic and biliary disease. The current standard is to conduct ERCP under conscious sedation (CS). Patient movement and agitation during ERCP under CS can result in procedure failure and complications. Aiming to reduce procedure failure rates and complications, Kelowna General Hospital (KGH) in British Columbia, Canada transitioned to performing ERCP under general anesthesia (GA) as the practice standard. Objective To determine if conducting ERCP under GA compared to CS decreases procedure complications, particularly post-ERCP pancreatitis (PEP). Methods The charts of 2,198 patients who underwent ERCP at KGH between 2015 and 2020 were reviewed. Before September 17, 2017, ERCP was performed under CS (n = 1,316). Afterwards, ERCP was conducted under GA (n = 882). Demographic, clinical, and procedural data were extracted. The data were analyzed using univariate and multivariate statistical analysis. Results Procedure failure rates (CS = 9 percent, GA = 3 percent, P < 0.001) decreased in the GA cohort after adjusting for age, sex, and co-morbidities. Thirty-day mortality, intensive care unit (ICU) transfer, returns post-discharge, PEP, and cholangitis rates were similar between cohorts. Conclusion Performing ERCP under GA compared to CS resulted in an increase in procedural success rates. Other complication rates were similar between groups.
doi_str_mv 10.1093/jcag/gwad037
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The current standard is to conduct ERCP under conscious sedation (CS). Patient movement and agitation during ERCP under CS can result in procedure failure and complications. Aiming to reduce procedure failure rates and complications, Kelowna General Hospital (KGH) in British Columbia, Canada transitioned to performing ERCP under general anesthesia (GA) as the practice standard. Objective To determine if conducting ERCP under GA compared to CS decreases procedure complications, particularly post-ERCP pancreatitis (PEP). Methods The charts of 2,198 patients who underwent ERCP at KGH between 2015 and 2020 were reviewed. Before September 17, 2017, ERCP was performed under CS (n = 1,316). Afterwards, ERCP was conducted under GA (n = 882). Demographic, clinical, and procedural data were extracted. The data were analyzed using univariate and multivariate statistical analysis. Results Procedure failure rates (CS = 9 percent, GA = 3 percent, P &lt; 0.001) decreased in the GA cohort after adjusting for age, sex, and co-morbidities. Thirty-day mortality, intensive care unit (ICU) transfer, returns post-discharge, PEP, and cholangitis rates were similar between cohorts. Conclusion Performing ERCP under GA compared to CS resulted in an increase in procedural success rates. Other complication rates were similar between groups.</description><identifier>ISSN: 2515-2084</identifier><identifier>EISSN: 2515-2092</identifier><identifier>DOI: 10.1093/jcag/gwad037</identifier><identifier>PMID: 38596806</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><subject>Original</subject><ispartof>Journal of the Canadian Association of Gastroenterology, 2024-04, Vol.7 (2), p.154-159</ispartof><rights>The Author(s) 2023. Published by Oxford University Press on behalf of the Canadian Association of Gastroenterology. 2023</rights><rights>The Author(s) 2023. 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The current standard is to conduct ERCP under conscious sedation (CS). Patient movement and agitation during ERCP under CS can result in procedure failure and complications. Aiming to reduce procedure failure rates and complications, Kelowna General Hospital (KGH) in British Columbia, Canada transitioned to performing ERCP under general anesthesia (GA) as the practice standard. Objective To determine if conducting ERCP under GA compared to CS decreases procedure complications, particularly post-ERCP pancreatitis (PEP). Methods The charts of 2,198 patients who underwent ERCP at KGH between 2015 and 2020 were reviewed. Before September 17, 2017, ERCP was performed under CS (n = 1,316). Afterwards, ERCP was conducted under GA (n = 882). Demographic, clinical, and procedural data were extracted. The data were analyzed using univariate and multivariate statistical analysis. Results Procedure failure rates (CS = 9 percent, GA = 3 percent, P &lt; 0.001) decreased in the GA cohort after adjusting for age, sex, and co-morbidities. Thirty-day mortality, intensive care unit (ICU) transfer, returns post-discharge, PEP, and cholangitis rates were similar between cohorts. Conclusion Performing ERCP under GA compared to CS resulted in an increase in procedural success rates. 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Results Procedure failure rates (CS = 9 percent, GA = 3 percent, P &lt; 0.001) decreased in the GA cohort after adjusting for age, sex, and co-morbidities. Thirty-day mortality, intensive care unit (ICU) transfer, returns post-discharge, PEP, and cholangitis rates were similar between cohorts. Conclusion Performing ERCP under GA compared to CS resulted in an increase in procedural success rates. Other complication rates were similar between groups.</abstract><cop>US</cop><pub>Oxford University Press</pub><pmid>38596806</pmid><doi>10.1093/jcag/gwad037</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record>
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title Endoscopic Retrograde Cholangiopancreatography Under General Anesthesia Compared to Conscious Sedation Study
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