Background: Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive procedure that proves burdensome to patients. Nevertheless, very little data are available on patient tolerance of this procedure that may improve practice guidelines and could aid in decreasing the burden of ERCP. This study therefore investigated the burden of ERCP performed with the patient under conscious sedation. Methods: Consecutive patients receiving ERCP under conscious sedation between November 2007 and December 2008 at the University Medical Center Utrecht and Erasmus MC Rotterdam (The Netherlands) were asked to participate in this study. The patients completed questionnaires on demographics, medical history, burden of ERCP (mental health, discomfort, and pain), symptoms and the EuroQol-5D (EQ-5D), including the EQ-VAS (lower EQ-5D scores and higher EQ-VAS scores represent a better quality of life). The paired t-test, the Kruskal-Wallis test, Pearson correlation, and logistic regression were used to evaluate the results. Results: The questionnaire was returned by 149 (54%) of 276 eligible patients, 139 of whom completed the entire questionnaire (54% males; mean age, 60 ± 14 years). Throat ache (p<0.001) was the only symptom higher than baseline value 1 day after the ERCP. On day 1, about onetenth of the patients experienced moderate to severe mental health problems, which were associated with a higher EQ-5D score before ERCP (p = 0.01). Slightly fewer than half of the patients experienced pain and discomfort during and immediately after ERCP. More discomfort was experienced by patients who underwent therapeutic ERCP (p< 0.05) and those with a higher EQ-5D score (p<0.001) or lower VAS (p<0.01). Pain was associated with younger age (p<0.01), higher EQ-5D score (p<0.001), and lower VAS (p<0.01). Conclusion: One-third to one-half of patients experience pain and discomfort during and immediately after ERCP when it is performed with conscious sedation for the patient. Other sedation strategies, such as the use of general anesthesia or propofol, may well reduce the burden of ERCP, particularly for patients with a higher EQ-5D score, younger age, or therapeutic ERCP treatment. However, randomized trials are warranted.

Conscious sedation, Endoscopic retrograde cholangiopancreatography, ERCP,
Surgical Endoscopy: surgical and interventional techniques
Department of Gastroenterology & Hepatology

Jeurnink, S.M, Steyerberg, E.W, Kuipers, E.J, & Siersema, P.D. (2012). The burden of endoscopic retrograde cholangiopancreatography (ERCP) performed with the patient under conscious sedation. Surgical Endoscopy: surgical and interventional techniques, 26(8), 2213–2219. doi:10.1007/s00464-012-2162-2