Same day endoscopic retrograde cholangio-pancreatography immediately after endoscopic ultrasound for choledocholithiasis is feasible, safe and cost-effective.

BACKGROUND Patients with suspected choledocholithiasis should undergo further confirmatory imaging test by endoscopic ultrasound (EUS) or magnetic resonance cholangiopancreatography (MRCP) before performing definite extraction by endoscopic retrograde cholangiopancreatography (ERCP). Usually, those procedures are performed at a separate session. AIM The aim of our study is to report the safety, efficacy and cost-effectiveness of same day EUS and ERCP. METHODS A retrospective study including all patients who underwent EUS and ERCP for choledocholithiasis from 1st January 2020 through 1st January 2021. Patients were categorized into same day EUS and ERCP (group A) and separate day procedures (group B). Univariate descriptive analysis was done to compare between the groups and cost-effectiveness analysis was based on the length of hospitalization. RESULTS Sixty-one patients (57.5%) underwent same day EUS and ERCP (group A), as compared to 45 patients (42.5%) who had separate sessions (group B). The average ages in groups A and B were 66.1 ± 20.7 years and 65.8 ± 19.3 years, respectively (p = .47). There was no difference in the mean doses of midazolam, propofol and fentanyl in EUS and ERCP examinations in both groups. Notably, group A had a significantly lower hospitalization length as compared to group B (7.4 ± 2.9 vs. 9.7 ± 3.9 days, p = .0003). Consequently, same day EUS and ERCP was associated with a significant cost saving as compared to group B (7680.9$ ± 3071.4$vs 10089.4$±4053.4$, p = .0003), respectively. There was no serious anesthesia related adverse events. CONCLUSION Same day EUS and ERCP for choledocholithiasis was safe and cost-effective with significant lower hospitalization length.