Further Results of Incorporating Innovative Procedures in a Surgical Residency

Endoscopic Retrograde Cholangiopancreatography in General Surgery: How Much are We Outsourcing?

Although surgeons can safely perform endoscopic retrograde cholangiopancreatography (ERCP), it has fallen within the domain of gastroenterologists. We sought to quantify the role of ERCP in a tertiary-care surgery department. The hospital discharge database was queried for all ERCPs performed from January 2007 to December 2007. Gastroenterologists performed all ERCPs in our query. Surgical patients were admitted and/or under the care of a surgeon; whereas nonsurgical patients had no surgeon involvement. Patient characteristics and diagnoses were compared between groups. ERCP procedural details were recorded. Surgical patients comprised 48 per cent (n = 151) of the total 311 ERCPs performed. The mean time interval from a surgeon's request for ERCP to actual procedure was 2.43 days (standard deviation [SD] 2.55; range, 0-13 days). The surgical group had significantly different diagnoses and underwent less diagnostic (22% vs 56%) and more therapeutic ERCPs (72% vs 38%). Surgical patients were more likely inpatients (82.1% vs 16.8%) with a longer length of stay (6.7 vs 3.9 days; P = 0.0029) compared with nonsurgical patients. We found surgical patients requiring ERCP differ significantly from nonsurgical patients, with a significant number of technical interventions being outsourced. Given the benefits of a surgical ERCP program and the potential volume of these unique patients, this procedure should be performed by appropriately trained surgeons.