Background: Patients who undergo EUS for evaluation of pancreatic lesions often also undergo a diagnostic or therapeutic ERCP. Typically, these procedures are scheduled on different days, but recently we have begun to schedule these procedures on the same day for patient's convenience. We report our experience with same-day EUS and ERCP (combo) to evaluate feasibility, cost, complications, and medications used. Methods: 28 consecutive patients who underwent same day EUS and ERCP were compared to an equal number of indication- and endoscopist-matched controls for both EUS and ERCP performed on different days. At our institution, EUS is performed in the endoscopy suite, and ERCP is performed in the radiology suite. In the combination group, EUS was done first followed by ERCP (range of time delay 45-120 min.). Results: Combo EUS ERCP % Combo ↓ Age a (range) 51 (27-82) 62 (26-81) 59 (19-82) Sex (M:F) / N 17:11 (28) 13:15 (28) 14:14 (28) Procedure time a 105 min. 89.7 min. 35.3 min. 16.0% Versed a 14.6 mg 9.6 mg 8.3 mg 18.4% Demerol a 149.6 mg 100.9 mg 86.6 mg 20.2% Droperidol a 3.25 mg 2.0 mg 2.0 mg 18.8% Complications b 2 (7.6%) 0 0 Procedure cost a,c $ 720.65 d $ 355.79 e $ 544.14 e 37% a Mean values. b Two patients had transient hypotension, which responded to IV fluids. In addition, two patients in the combination group had marked increase of intestinal motility during ERCP requiring glucagon, atropine and somatostatin to achieve control. c Professional fees only. d Includes all payers. e Medicare schedule fees. Conclusion: (1) Combined EUS/ERCP can be safely done. (2) The procedure time for the combined procedure was on the average 20 minutes shorter, perhaps due to a more rapid sedation time for the ERCP. (3) Roughly 20% less medication for conscious sedation was required which could add to important savings for both patients and endoscopy units. (4) Procedure cost for the combined EUS/ERCP is less than the two examinations performed on separate days, but additional expenses, including indirect and intangible costs (e.g. absenteeism from work, patients' transportation, parking fees, nursing time and in-hospital transportation), were not calculated.
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging