Comparison of ercp procedures with sedation and ERCP procedures with general anesthesia

ABSTRACT In this study, ERCP procedures of 2425 patients between January 2016 and December 2018 in the ERCP Unit of Afyonkarahisar Health Sciences University Faculty of Medicine, Department of General Surgery were retrospectively analyzed.Among these patients, 500 patients were included in the ERCP procedure performed with sedation, while 500 patients were included in the ERCP procedure performed under general anesthesia. It was aimed to compare the safety and effectiveness of ERCP procedures performed under general anesthesia and ERCP procedures performed with sedation in patients with various parameters. A total of 1000 patient files were found from the hospital automation system, and the ages, genders, ERCP reports, laboratory findings and epicrisis of the patients at the time of the procedure were examined retrospectively. Patients under the age of 18 and over the age of 90 were excluded from the study. All procedures were performed by the same general surgeon. Procedures performed by different specialists, insufficient data, patients whose anesthesia type could not be determined, repetitive ERCP procedures during the same hospitalization, pregnant patients, and patients who started the ERCP procedure with sedation and switched to general anesthesia during the procedure were excluded from the study. Nausea and vomiting, anaphylaxis or allergic reaction, cardiovascular collapse, cardiac arrest, prolonged hypotension for 1 minute, bronchospasm, desaturation under anesthesia, postoperative desaturation, tooth damage and anesthesia complications, as well as pancreatitis, bleeding, perforation and other surgical complications were recorded. In this study, the successful cannulation rate was 97.8%, while the precut rate was 4.7%. In our study, the overall mortality rate was found to be 2.4%, and at least one type of complication such as bleeding, pancreatitis and acute kidney failure was observed in 121 (12.1%) patients. Pancreatitis complication was seen in 99 cases (9.9%) and was the most common complication. At least one type of complication such as bleeding, pancreatitis and acute renal failure was observed in 47 (9.4%) of 500 patients who underwent ERCP with sedation. Only one complication was seen in all of these 47 patients. At the same time, none of the complications such as bleeding, pancreatitis and acute renal failure were observed in 453 (90.6%) patients. The rate of successful cannulation was found to be 2.4% higher in the sedation group than in the general anesthesia group. When the mortality rate was compared in both groups, it was found to be higher in the general anesthesia group. The precut rate was found to be higher in the sedation group than in the general anesthesia group. The rate of acute renal failure was found to be higher in the general anesthesia group than in the sedation group. In order to obtain higher cannulation rates in ERCP and to reduce the post-procedure complication rates, this procedure should be performed in experienced centers. Key Words: Endoscopi, Endoscopic retrograde cholangiopancreatography (ERCP), Sedation, General anesthesia, Pancreatitis