Outpatient therapeutic ERCP with endobiliary stent placement for malignant common bile duct obstruction

Background: Since 1996 patients in stable condition who need therapeutic endoscopic retrograde cholangiopancreatography (ERCP) at our institution have been treated as outpatients whenever possible. We reviewed our institution's experience and compared outpatient versus inpatient therapeutic ERCP for endobiliary stent placement in the care of patients with malignant common bile duct obstruction. Methods: A retrospective review of all therapeutic ERCPs for the palliation of malignant common bile duct obstruction with endobiliary stents was performed from March 1, 1996, through December 1, 1997. Results: One hundred nine therapeutic ERCPs were performed on 84 patients to place a polyethylene endobiliary stent for malignant common bile duct obstruction, Forty-three procedures were performed on 31 outpatients, 66 on 53 inpatients. There was no significant difference between outpatient and inpatient groups with regard to age, gender, procedure success rate, complication rate, need for endoscopic sphincterotomy, or whether the procedure was for initial stent placement or stent exchange. Inpatients had no procedure-related complications; outpatients had two. There was no procedure-related mortality in either group. Conclusion: Therapeutic ERCP for palliation of malignant common bile duct obstruction can be safely and successfully performed on an outpatient basis for selected patients. This should result in better quality of life for these patients with advanced cancer and substantial cost savings.