Emergency endoscopic retrograde cholangiopancreatography in critically ill patients

Background: The aim of this study was to assess the frequency, indications, yield, and outcome of emergency endoscopic retrograde cholangiopancreatography (ERCP) in critically ill patients. Methods: Records of all intensive care unit patients undergoing emergency ERCP were reviewed over a 40-month period. Indications, findings, therapeutic interventions, and survival were analyzed. Those requiring mechanical ventilation at the time of ERCP were in group A and those who did not were in group B. Results: Of 1781 ERCP, 32 (1.80%) were performed on intensive care unit patients. Fifteen patients belonged to group A (46.87%) and 17 (53.13%) to group B. The common bile duct was the duct of interest in 30 patients (94%) and was cannulated in 97%. Indications included possible biliary sepsis (68.75%), gallstone pancreatitis, and jaundice (12.5% each). The most common finding was choledocholithiasis (34%), followed by failure to fill the cystic duct (16%) and common bile duct stricture (9%). A normal examination was present in 18.75% of cases. Endoscopic therapy was required in 66.6% of patients in group A and 70.5% of group B. The overall 30-day mortality was 25% (33% for group A and 17.6% for group B) and not related to the ERCP. Conclusions: Two percent of all ERCPs performed were on intensive care unit patients (47% requiring mechanical ventilation) primarily to evaluate for possible biliary sepsis. Technical success was not compromised by mechanical ventilation. Therapeutic intervention was required in more than two thirds of patients and the overall 30-day mortality was 25%.