Sequential endoscopist-driven phone calls improve capture rate of adverse events after ERCP: a prospective study.

BACKGROUND AND AIMS: ERCP is a high-risk endoscopic procedure, yet reports of ERCP-related adverse events are largely limited to early adverse events, based on immediate postprocedure assessment. We hypothesize that immediate/1-day follow-up underestimates the true adverse event rate, and later follow-up calls may enable a more accurate assessment of adverse events, leading to enhanced postprocedural patient care.

METHODS: Consecutive patients undergoing ERCP at our tertiary care academic medical center from 2018 to 2019 were analyzed. Patients were encouraged to contact us with postprocedure symptoms and additionally received phone calls at 1, 7, 14, and 30 days after the procedure using a standardized script to assess for delayed adverse events and unplanned healthcare encounters.

RESULTS: This study is notable for a high rate of successful patient follow-up at day 1 (94%) and day 7 (93%). The assessed overall adverse event rate was 1.9% immediately postprocedure, 3.3% on day 1, and 9.8% on day 7. Increased detection of adverse events was accomplished by the day 7 call relative to the day 1 call (pancreatitis 2% vs 0.5%; bleeding 0.5% vs 0.2%; infection 0.9% vs 0.5%). 14- and 30-day follow-up calls were lower yield in detection of post-ERCP adverse events.

CONCLUSIONS: Initial postprocedure assessment and day 1 follow-up calls underestimate adverse event rates/UHE related to ERCP, due to delayed evolution of some adverse events. The day 7 call is optimal in that it resulted in a >3-fold higher rate of detection of adverse events and successful direction of over 10% of symptomatic patients to appropriate assessment and follow-up heath care.