P138 Delays in cholecystectomy after bile duct clearance: another consequence of Covid-19?

• Published in: Gut Vol. 71; no. Suppl 1; pp. A108 - A109
• Main Authors: Ahmed, Wafaa, Obeng, Laurenda, Hegazy, Amr, Jamil, Khaleel
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Society of Gastroenterology 19.06.2022; BMJ Publishing Group LTD
• Subjects: Bile ducts; Biliary tract; Cannulation; Cholangitis; Cholecystectomy; Cholecystitis; Coronaviruses; COVID-19; Endoscopy; Intolerance; Pandemics; Patients; Poster presentations; Surgery
• ISSN: 0017-5749; 1468-3288
• DOI: 10.1136/gutjnl-2022-BSG.194

IntroductionEndoscopic retrograde cholangiopancreatography (ERCP) is frequently performed as a therapeutic procedure for the treatment of choledocholithiasis. After biliary tract gallstones have been cleared at ERCP, cholecystectomy is often indicated to prevent further complications. The COVID-19 pandemic has led to delays and cancellations of non-urgent surgery. We sought to assess whether such delays were associated with readmission with biliary symptoms.MethodsRetrospective analysis of consecutive ERCPs performed over a 6-month period in 2019 in a high volume centre. Recorded variables included patient demographics, procedure characteristics, response to therapy and follow up data. Time to cholecystectomy and readmission data was analysed. Comparison between means was made using the paired t-test.ResultsWe identified 178 ERCP procedures performed during the study period, with adequate dataset available for 163. The median age was 71 years (range 23-101), and 85 patients (52%) were females. Ninety-seven (60%) procedures were performed as inpatients. The most frequent indications were choledocholithiasis (n=97, 60%) and biliary strictures (n=50, 31%). The procedure was abandoned due to patient intolerance or scope failure in 6 (4%)cases; the ampulla was not visualised due to surgery, infiltration or diverticulum in 8 (5%) cases. of the remaining 149 procedures CBD cannulation was successful in 140 (94%).A positive diagnosis of CBD stones was made in 74 (45%) cases. Thirty-three (45%) cases were referred for cholecystectomy; 18 (55%) underwent cholecystectomy, 4 (13%) declined surgery, 4 (13%) were deemed too high risk, and 3 (9%) remain on the waiting list. Mean time to cholecystectomy was 191 days (range 18-838 days). While on the waiting list for cholecystectomy, 5 (15%) patients required readmission with recurrent biliary symptoms - three for recurrent choledocholithiasis, one for acute cholecystitis and one for cholangitis. These patients waited longer for cholecystectomy compared with those that did not require readmission (436 vs 59 days, p<0.0001), with 4 of the 5 (80%) waiting more than 1 year.ConclusionsOur study demonstrates that delays in elective cholecystectomy after endoscopic bile duct clearance is associated with patient readmission as a result of biliary pathology. We postulate that the COVID-19 pandemic has significantly contributed to these delays, and our study highlights the urgent need to direct resources to address waiting times for ‘non-urgent’ surgery.