TBA (24W101)

The Impact of Permanent Stent Insertion on Irish ERCP KQIs

Author(s)

E. Keating (1,2), G. Bennett (1,2), H. Martir (1), B. Kelleher (1,2), S. Stewart (1,2), N. Ramlaul (1,2), J. Leyden (1,2)

Department(s)/Institutions

1. Endoscopy Unit, Mater Misericordiae University Hospital 2. School of Medicine, University College Dublin

Introduction

Complete ductal clearance traditionally defines ERCP success in choledocholithiasis and is a mandatory ERCP key quality indicator (KQI). However, ERCPs are increasingly completed on elderly or frail patients with extensive comorbidities.

Aims/Background

To minimise the risks of repeated ERCPs, permanent stent insertion (PSI) as definitive therapy may be considered in select patients but this may adversely affect ERCP KQIs.

Method

A retrospective analysis of a prospectively-maintained ERCP database for outcomes among elderly patients undergoing PSI over 2 years.

Results

1116 procedures were completed over 24 months with choledocholithiasis cases accounting for 61.8% (n=690/1116). Patients over 80 accounted for 23.2% (n=160) of choledocholelithiasis ERCPs. Stent insertion rates for patients >80 years of age were 33.8% vs 20.4% of <80 years (p<0.001, OR 1.673 [95% CI 1.253, 2.234]). >85 years of age, stent insertion was completed in 41.8% vs 21.3% of <85 years (p<0.001, OR 2.354 [95% CI 1.500, 3.695]. >90 years of age, stent insertion was completed in 57.1% vs 22.3% of <90 years (p<0.001, OR 4.372 [95% CI 1.878, 10.181]). 6.7% of choledocholithiasis patients underwent declared PSI with 10-French stents (46/690). Median patient age was 87 (range 66-97). Median interval since PSI ERCP was 322 days (range 6-742). Only 8.7% of PSI patients (n=4/46) have required re-intervention post-PSI at a median interval of 108 days (range 54-232). Post-ERCP complications (pancreatitis) occurred in 4.3% of PSI patients (2/46).

Conclusions

PSI is increasingly used for elderly patients to minimise ERCP complication risks. Appropriate patient selection for PSI depends on clinician judgement and age is often used as a surrogate marker. As ductal clearance rates are an important ERCP KQI, PSI may need to be considered as a definitive clearance strategy in select patients.