Association of procedure length on outcomes and adverse events of endoscopic retrograde cholangiopancreatography.
OBJECTIVE
The aims of this study were to determine the effects of length of procedure on endoscopic retrograde cholangiopancreatography (ERCP) outcomes and adverse events.


METHODS
All ERCP procedures, performed by experienced advanced endoscopists, in patients without prior papillary intervention from 2006 to 2008 were reviewed. Procedures were arbitrarily divided into two groups: shorter procedures (SP), with a duration shorter than the overall mean procedure length, and longer procedures (LP), with a duration longer than overall mean procedure length. Length of procedure was defined as the time from endoscope insertion to endoscope removal.


RESULTS
Two hundred and ninety-five procedures were included in the analysis. Mean procedure length was 45.6 ± 30.1 min. One hundred and seventy-seven procedures (60%) were SP and 118 (40%) were LP. There were no differences between the groups with regard to patients' ages, genders, race, or trainee participation. SP cases were more likely to be biliary vs pancreatic or bi-ductal evaluations (P = 0.03). LP had significantly higher complexity scores (34% with >3 vs 13%; P = 0.046) and were more likely to require pre-cut papillotomy (39% vs 15%; P < 0.001). There was no significant difference between the groups in overall completion rates (91.5% LP vs 96% SP; P = 0.10) or adverse events (10.2% LP vs 6.2% SP; P = 0.21). However, LP cases were associated with higher rates of post-ERCP bleeding (4.2% vs 0.6%; P = 0.029).


CONCLUSIONS
There was no significant difference in outcomes or overall adverse events between shorter and longer ERCP procedures. However, longer procedures were associated with higher procedure complexity, higher utilization of pre-cut technique, and increased risk of bleeding.
Digestive Disease Institute, Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland OH, USA and Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA.
Paresh P
PP
Mehta
Madhusudhan R
MR
Sanaka
Mansour A
MA
Parsi
Mazen J
MJ
Albeldawi
John A
JA
Dumot
Rocio
R
Lopez
Gregory
G
Zuccaro
John J
JJ
Vargo
adverse events; duration of procedure; endoscopic retrograde cholangiopancreatography (ERCP); pancreatitis