Biliary endoscopic drainage of septic ICU patients deemed emergent (BEDSIDE): a retrospective cohort study (2012–2022)

BACKGROUND: Mortality for severe acute cholangitis is significantly reduced after endoscopic biliary drainage. Our institution has utilized endoscopic retrograde cholangiopancreatography (ERCP) without fluoroscopy in the intensive care unit (ICU), termed Biliary Endoscopic Drainage of Septic ICU patients Deemed Emergent (BEDSIDE) ERCP, in rare circumstances for critically ill patients with severe acute cholangitis where timely conventional ERCP was not available and delayed biliary drainage could adversely affect clinical outcomes. The objective of this study is to describe the BEDSIDE technique and its feasibility to provide expedited biliary drainage in critically ill patients in the ICU with severe acute cholangitis where timely conventional ERCP was not available. METHODS: We performed a retrospective cohort study from 2012 to 2022 at our tertiary care hospital system of patients who underwent BEDSIDE ERCP for acute cholangitis. Data collection included demographics, hospital course, and endoscopic findings. RESULTS: We identified 14 patients who underwent BEDSIDE ERCPs. Identified patients were critically ill with high incidences of vasopressor requirements (79%), mechanical ventilation (43%), and systemic inflammatory response syndrome (SIRS) (100%). Median time from admission to ERCP was 13.6 h (range 9.3-18.5 h). BEDSIDE approach had successful biliary stent placement in 11 patients (79%), including all 5 patients with prior biliary sphincterotomies. 30-day cholangitis-related mortality was 14%. CONCLUSION: BEDSIDE ERCP is proposed as a feasible approach to expedited biliary drainage for critically ill patients in the ICU with severe acute cholangitis in the rare circumstances that timely conventional ERCP with fluoroscopy is unavailable and further delayed biliary drainage could negatively affect clinical outcomes.