High Risk Therapeutic Endoscopy Can Be Performed Safely in an Ambulatory Surgical Center: A Multicenter, Prospective Study

Introduction: Even amongst experienced endoscopists, endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound with fine needle aspiration (EUS-FNA) carry a potential risk for complications. These procedures are typically performed in a hospital-based endoscopy unit with general anesthesia. The goal of our study was to evaluate the feasibility of ERCP, EUS-FNA in an ambulatory surgical center (ASC). Methods: From June to November of 2014 we prospectively enrolled consecutive patients undergoing ERCP and/or EUS-FNA in an ASC. An anesthesiologist, who not involved in our study group, screened all patients prior to their scheduled procedure. In order to monitor for adverse events (AE), all patients received a telephone call at day 1 and 30 post-procedure. Results: 375 patients, (98 inpatients and 277 from an ASC) were enrolled. A high proportion of patients underwent procedures for neoplasms [21(23.3%) inpatient versus 44(17.1%) ASC], for sphincter of Oddi dysfunction (SOD)[27(27.5%) v. 48(17.3%)], had the American Society for Anesthesiologists (ASA) class > III [75(76.5%) v. 140(50.5%)] and high-risk features [17(17.3%) v. 75(27.1%)]. Overall post-ERCP AE [10(13.2%) v. 12(7.5%), p=0.2], pancreatitis [7(9.2%) v. 11(6.9%), p=0.6], hemorrhage [3.9% v. 0.6%, p=0.25] were not different between inpatients and ASC patients. There was also no difference between inpatient and ASC patient's post-EUS AE [1(4.5%) v. 4(3.4%), p=0.6], pancreatitis [1(4.5%) v. 3(2.6%), p=0.2] and hemorrhage [0% v. 1(0.9%), p=0.9]. Conclusion: ERCP and EUS can be performed in a higher risk population under the supervision of anesthesia in ASCs. Overall the AE are equivalent between in and ASC patients.Table 2: Outcomes and Cost for Inpatient versus ASC ERCP, EUS, and the Combined PopulationFigure 1