Quality statement 3: Emergency endoscopic retrograde cholangiopancreatography within 24 hours

Quality statement

Adults with common bile duct stones who need emergency endoscopic retrograde cholangiopancreatography have it within 24 hours.

Rationale

Endoscopic retrograde cholangiopancreatography can be used to treat common bile duct stones. Not everybody will need this procedure within 24 hours, but emergency endoscopic retrograde cholangiopancreatography can improve outcomes for adults with acute cholangitis or acute pancreatitis if their condition is not responding to antibiotics or intravenous fluids. Delaying endoscopic retrograde cholangiopancreatography for adults with these conditions risks complications such as sepsis.

Quality measures

Structure

Evidence of local arrangements to ensure that adults with common bile duct stones who need emergency endoscopic retrograde cholangiopancreatography have it within 24 hours.

Data source: Local data collection.

Process

Proportion of adults with common bile duct stones who need emergency endoscopic retrograde cholangiopancreatography who have it within 24 hours.

Numerator – the number in the denominator who have endoscopic retrograde cholangiopancreatography within 24 hours.

Denominator – the number of adults with common bile duct stones who need emergency endoscopic retrograde cholangiopancreatography.

Data source: Local data collection.

Outcome

Rates of sepsis in adults with common bile duct stones.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (such as secondary care services) ensure that healthcare professionals are trained to perform endoscopic retrograde cholangiopancreatography, and that adults with common bile duct stones who need this procedure in an emergency can have it within 24 hours. For 24‑hour endoscopic retrograde cholangiopancreatography, service providers may need to be aware of local networks.

Healthcare professionals (such as gastroenterologists, radiologists and upper gastrointestinal surgeons) are trained to perform endoscopic retrograde cholangiopancreatography, and provide it for adults with common bile duct stones who need it in an emergency within 24 hours.

Commissioners (such as clinical commissioning groups) monitor services that offer endoscopic retrograde cholangiopancreatography to ensure that they regularly perform it, and that adults with common bile duct stones can have it as an emergency within 24 hours if needed.

What the quality statement means for patients and carers

Adults with common bile duct stones are able to have an endoscopy (inserting a thin, flexible tube down their throat to perform surgery inside their body) within 24 hours if they need it in an emergency. The endoscopy is to remove the stones in their bile duct (part of the digestive system that is connected to the gallbladder) and prevent other problems such as blockages, inflammation or infection.

Source guidance

Definitions of terms used in this quality statement

Emergency endoscopic retrograde cholangiopancreatography

Emergency endoscopic retrograde cholangiopancreatography (within 24 hours) is needed for adults with common bile duct stones and acute cholangitis or acute pancreatitis when indicated.

[Adapted from gallstone disease (NICE guideline CG188) recommendations 1.3.1 and 1.3.2, and Royal College of Surgeons (2013) Commissioning guide: gallstone disease, section 1.2 and expert consensus]