EP 016 Evaluating the Impact of Acute Non-Operative Management of Symptomatic Gallstones on our Endoscopic Retrograde Cholangiopancreatography Service in a Busy District Teaching Hospital

Aims

Due to insufficient resources, our institution largely employs a non-operative approach to acute gallstone presentations. The aim of this service review was to establish the impact of this on the endoscopic retrograde cholangiopancreatography (ERCP) service and associated bed days.

Methods

13 codes were used to identify symptomatic gallstone patients admitted to general surgery in March 2024. The first presentation of the patient's gallstones was identified, the timeframe of this was 26/04/2017 – 09/05/2024. ERCP data were extracted for all patients requiring an ERCP on the first admission or subsequent admissions. Data was analysed in Excel.

Results

250 records were identified. Following exclusion, 72 patients were identified. AdmissionFirst AdmissionPost First AdmissionNumber of ERCP’s6.9% (5/72)3 CBD stones2 Cholangitis23.6% (17/72) – 23 in total15 CBD Stone (2 Stent)4 Cholangitis (1 Stent)2 Biliary stricture (2 Stents)1 Bile leak1 Stent removal

All first admission ERCP’s were performed as inpatient. In subsequent readmissions 82.6% (19/23) were performed as outpatient. The median time to ERCP from request was 10 days in both cohorts (Range 2-14 days in first admission and 2-29 days in readmission.)

Conclusions

Wait time for ERCP accounts for a substantial number of inpatient bed days and the impact of not operating acutely increases the burden on ERCP services. Rationalising the ERCP pathway and implementing an urgent cholecystectomy service would result in significant cost savings which could support the development of business cases.