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Discovering Adverse Events By Phone – the Sweet Spot is 7 Days After ERCP

Bret T. Petersen, MD, MASGE, reviewing Barakat MT, Banerjee S. Gastrointest Endosc 2020 Jul 25.

Identification of adverse events following gastrointestinal endoscopy can be challenging due to patient reticence to present for mild to moderate problems and dispersed follow-up among multiple practitioners and institutions for more significant events. Endoscopic retrograde cholangiopancreatography (ERCP) is associated with greater risk than most endoscopic procedures, yet many adverse events are not detected due to their gradual development hours and days after dismissal from outpatient procedures. 

In this study, the authors compared the rate of adverse events, identified by phone calls using a standardized script, at 1, 7, 14, and 30 days post-ERCP. Patients were also encouraged to report postprocedure symptoms as they occurred. During a 1-year interval, sequential patients were successfully contacted by phone in a high proportion of cases (day 1, 94%; day 7, 93%; day 14, 82%; day 30, 74%). Post-ERCP adverse events were most commonly identified at the day 7 visit (9.8%), compared to the immediate postprocedure time frame (1.9%) and day 1 (3.3%). The yield of further identification of adverse events beyond the first week was lower. This was significant for day 7 versus day 1 for pancreatitis (2% vs 0.5%), bleeding (0.5% vs 0.2%), and infection (0.9% vs 0.5%). Guidance was provided for patient follow-up based on identified events in more than 10% of symptomatic patients.

Bret T. Petersen, MD, FASGE

COMMENT

Physician awareness of the occurrence of adverse events is important for optimal care of individual patients and, in some cases, for maturation of endoscopy center processes and physician judgment. Following ERCP, many events are not fully developed or realized by patients or physicians for up to several days later. The confirmation of optimal detection of events at 1 week postprocedure fits with most study protocols and general experience. Some authors have demonstrated the utility of a multipronged solicitation of notification about symptoms and events from patients, families, and referring providers in addition to email and evening phone calls when patients or families might be most accessible.

 

 

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

CITATION(S)

Barakat MT, Banerjee S.  Sequential endoscopist-driven phone calls improve capture rate of adverse events after ERCP: a prospective study. Gastrointest Endosc 2020 Jul 25. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2020.07.036)

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