PWE-152 Palliative biliary stenting; not so palliative in many cases!!

Abstract

were retrospectively reviewed. Only patients who were in the intensive care unit requiring ventilatory and/or inotropic support and general anaesthesia for stabilisation at the time of ERCP were included. Data collected included indications, co-morbidities, technical success and 30-day mortality. Results A total of 2237 ERCPs were performed during this period, out of which 36 (2%) emergency ERCP's were performed in 32 patients. There were 15 males and 17 females. 27/32 patients (84%) had not had previous ERCP. The median age of patients was 79 years (range 42e89). ASA grade prior to the presenting illness was 1 in 6 (17%); 2 in 15 (42%); 3 in 15 (42%). All cases were performed under general anaesthesia in emergency theatre. 27/36 cases (75%) required inotropic support. Indications included cholangitis 28/36 (78%); acute pancreatitis with cholangitis 5/36 (14%); post-operative bile leak 3/36 (8%). Biliary cannulation was achieved in all cases (100%). Endoscopic findings included: common bile duct (CBD) stones in 26/36 (72%); bile leak in 3/36 (8%); CBD stricture in 2/36 (6%); Mirizzi's in 1/36 (3%); blocked plastic stent in 1/36 (3%) and post-sphincterotomy bleed with clot obstruction in 1/36 (3%). Sphincterotomy was performed in 25/36 (69%) cases. 23/36 (64%) patients had stent insertion and in 11/36 (30%) patients balloon trawl was sufficient to clear the ducts. A rapid reduction in bilirubin was observed within 24e48 h following ERCP (Pre ERCP bilirubin: median 104, range 9e553 mmol/l; post ERCP bilirubin: median 29.5 range 12e217 mmol/l p<0.001 (Wilcoxon Signed rank test). 30-day mortality was 25% (8/32 patients) and the majority of these patients (6/8, 75%) died within 24 h of ERCP due to overwhelming sepsis. There was a single case of post sphincterotomy bleed that required a repeat procedure due to clot obstruction. There were no other procedure related complications. The median length of hospital stay was 21 days (range 2e49). Conclusion Although the 30-day mortality remains high due to multi-organ dysfunction, ERCP is successful in majority of these patients and translates to a good outcome for this cohort of critically ill patients, in whom the prognosis is inevitably poor without an emergency ERCP.