Day-case transfer of inpatients for diagnostic and therapeutic endoscopic retrograde cholangiopancreatography.

BACKGROUND: To use facilities flexibly and efficiently, a diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) service was offered to inpatients from referring hospitals on a day-case basis.
METHODS: Patients were transferred by ambulance with a nurse escort and returned to the parent hospital after a short period of recovery. The activity of this service was audited.
RESULTS: A total of 188 patients (70 men and 118 women of mean age 63.5 (range 22-94) years) were referred, 55 by physicians or geriatricians and 133 by surgeons from 19 hospitals up to 100 miles distant. Some 109 (58 per cent) had jaundice, 12 (6 per cent) cholangitis, seven (4 per cent) acute pancreatitis and 41 (22 per cent) abdominal pain. All patients arrived between 08:30 and 12:00 hours, all but 16 between 09:30 and 11:00 hours, and all but one with an escort; 129 patients travelled less than 10 miles. The mean time spent in the authors' hospital was 5.9 (range 2.2-9.5) h. The mean time spent away from the parent hospital by patient and escort was 7.0 (range 3.5-10) h. Cannulation failed in 12 patients (6 per cent), two with duodenal tumours. Sphincterotomy was performed in 70 cases, mechanical lithotripsy in seven and stents were inserted in 67. Nine patients were admitted, four for percutaneous stent insertion after failed ERCP and three for abdominal pain (one acute pancreatitis); two patients with sepsis and malignancy died after admission to this hospital. After return to the parent hospital, a further patient died following laparotomy for malignancy and five patients developed abdominal pain (three acute pancreatitis).
CONCLUSION: These findings show that short-stay ERCP can be undertaken on transferred inpatients safely and efficiently without adverse effect on success or complication rates.