Post ERCP mild pancreatitis frequency: Influence of hospital admission policy

S. Sherman, D. Earle, L. Bucksot, P. Fay, J. Flueckiger, E. Fogel, G. Lehman

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)AB148
JournalGastrointestinal endoscopy
Volume45
Issue number4
DOIs
StatePublished - Jan 1 1997

Fingerprint

Endoscopic Retrograde Cholangiopancreatography
Pancreatitis
Length of Stay
Outpatients
Inpatients
Amylases

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

Cite this

Post ERCP mild pancreatitis frequency : Influence of hospital admission policy. / Sherman, S.; Earle, D.; Bucksot, L.; Fay, P.; Flueckiger, J.; Fogel, E.; Lehman, G.

In: Gastrointestinal endoscopy, Vol. 45, No. 4, 01.01.1997, p. AB148.

Research output: Contribution to journalArticle

Sherman, S. ; Earle, D. ; Bucksot, L. ; Fay, P. ; Flueckiger, J. ; Fogel, E. ; Lehman, G. / Post ERCP mild pancreatitis frequency : Influence of hospital admission policy. In: Gastrointestinal endoscopy. 1997 ; Vol. 45, No. 4. pp. AB148.
@article{20b37f081cce4cbc954c7c361084a03c,
title = "Post ERCP mild pancreatitis frequency: Influence of hospital admission policy",
abstract = "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.",
author = "S. Sherman and D. Earle and L. Bucksot and P. Fay and J. Flueckiger and E. Fogel and G. Lehman",
year = "1997",
month = "1",
day = "1",
doi = "10.1016/S0016-5107(97)80494-4",
language = "English (US)",
volume = "45",
pages = "AB148",
journal = "Gastrointestinal Endoscopy",
issn = "0016-5107",
publisher = "Mosby Inc.",
number = "4",

}

TY - JOUR

T1 - Post ERCP mild pancreatitis frequency

T2 - Influence of hospital admission policy

AU - Sherman, S.

AU - Earle, D.

AU - Bucksot, L.

AU - Fay, P.

AU - Flueckiger, J.

AU - Fogel, E.

AU - Lehman, G.

PY - 1997/1/1

Y1 - 1997/1/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=33748957407&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33748957407&partnerID=8YFLogxK

U2 - 10.1016/S0016-5107(97)80494-4

DO - 10.1016/S0016-5107(97)80494-4

M3 - Article

AN - SCOPUS:33748957407

VL - 45

SP - AB148

JO - Gastrointestinal Endoscopy

JF - Gastrointestinal Endoscopy

SN - 0016-5107

IS - 4

ER -