S114 Impact of Procedure Duration on Outcomes and Anesthesia Events in Endoscopic Retrograde Cholangiopancreatography

Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) is a technically demanding procedure with variable durations that may influence clinical outcomes and resource utilization. This study aimed to investigate the associations between ERCP procedure time, specific procedural factors, and the incidence of adverse anesthesia-related events. Methods: We conducted a retrospective analysis of 363 ERCP procedures with complete data performed at King Abdullah Medical City, Kingdom of Saudi Arabia between January 2019 and June 2021. Patients were categorized into long (≥30 min) and short (<30 min) procedure groups. Data on demographics, procedural details (e.g., stone/stricture disease, Pre-cut, stent placement, lithotripsy, CBD clearance), and anesthesia events (e.g., vital sign fluctuations, intubation) were collected. A logistic regression model was developed to predict long procedure time based on binary procedural variables, demonstrating moderate discrimination (ROC-AUC 0.692). Results: Long procedures constituted a significant proportion of the cohort. Stone disease was more prevalent in short procedures (77.9% vs 37.1%, P < 0.001), while complex interventions such as stent placement (51.5% vs 30.2%, P < 0.001), lithotripsy (4.6% vs 0.6%, P = 0.042), and pre-cut usage (8.2% vs 3.6%, P = 0.099) were significantly more frequent in long procedures. Time to cannulation was also markedly longer in long cases (7.3 vs 3.6 min, P < 0.001). Importantly, combined anesthesia-related complications (pulse <60, SBP <90, O2 sat <90, apnea) or endotracheal intubation occurred significantly more often in the long procedure group (13.4% vs 5.9%, P = 0.028). The predictive model identified lithotripsy, pre-cut, and stent placement as the strongest predictors for prolonged procedure duration. Conclusion: Longer ERCP procedures are independently associated with more complex interventions, extended cannulation times, and a higher incidence of anesthesia-related adverse events. These findings underscore the importance of anticipating procedural complexity and optimizing anesthesia support to enhance patient safety and procedural efficiency in ERCP.