Cotton et al defined mild post-ERCP pancreatitis as clinical pancreatitis with serum amylase ≥ 3x normal requiring an unplanned hospitalization of an outpatient or prolongation of a planned hospital stay by 2-3 days (GI Endosc 1991;37:383). Prior to 1991 most ERCP's (especially therapeutic), included a planned hospital stay. Therefore, a 2-day extension was required to qualify for even mild post-ERCP pancreatitis. Since 1993-4, we have performed outpatient diagnostic and therapeutic ERCP's on most stable patients. Therefore, an unplanned post-ERCP pancreatitis admission of only I day would be tallied as a complication. Currently, a patient with an unplanned hospital stay of 47 hours would be tallied as 2 days of post-ERCP pancreatitis (but none when the admission was planned). AIM: to determine whether the frequency of mild post-ERCP pancreatitis has increased because of the shift from inpatient to outpatient procedures. METHODS: We queried the ERCP database on 3711 ERCP's (70% therapeutic) from 1994-96 for post-ERCP pancreatitis occurrence, severity, and length of hospital stay (LOS). Since 1994, post-ERCP pancreatitis occurrence was carefully tallied daily and all outpatients called within 24-72 hours. RESULTS: Post-ERCP pancreatitis was diagnosed in 302 patients (8.1%). Mild post-ERCP pancreatitis (by Cotton criteria) was noted in 208 patients (5.6%). The LOS for pancreatitis was 1 day in 1%, 2 days in 23%, and 3 days in 74%. Applying our pre-1993 admission policy, overall mild post-ERCP pancreatitis rate would have been only 4.3% if all 1- and 2-day admissions were excluded (4.3% vs 5.6% p < .01) SUMMARY: The increasing trend to perform outpatient ERCP causes the apparent mild post-ERCP pancreatitis rate and overall pancreatitis rate to increase. CONCLUSION: Caution must be exercised when comparing pre-1994 predominantly inpatient ERCP data to more recent predominantly outpatient studies. Further refinements in severity grading of post-ERCP pancreatitis are needed when comparing inpatients and outpatients.
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging