Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 6, 2021; 9(28): 8404-8412
Published online Oct 6, 2021. doi: 10.12998/wjcc.v9.i28.8404
Comparison of the impact of endoscopic retrograde cholangiopancreatography between pre-COVID-19 and current COVID-19 outbreaks in South Korea: Retrospective survey
Kook Hyun Kim, Sung Bum Kim
Kook Hyun Kim, Sung Bum Kim, Division of Gastroenterology and HepatologyDepartment of Internal Medicine, Yeungnam University, College of Medicine, Daegu 42415, South Korea
Author contributions: Kim KH designed the research and wrote the paper; Kim SB analyzed the clinical data and reviewed the manuscript.
Supported by the 2020 Yeungnam University Research Grant, No. 220A480002.
Institutional review board statement: This study was approved by the Institutional Review Board of Yeungnam University Hospital (IRB No. 2020-12-042).
Informed consent statement: Written informed consent was waived owing to the retrospective nature of this study.
Conflict-of-interest statement: The authors have no conflict of interest to declare.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kook Hyun Kim, MD, Professor, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University, College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu 42415, South Korea. kimkh@yu.ac.kr
Received: June 22, 2021
Peer-review started: June 22, 2021
First decision: July 16, 2021
Revised: July 22, 2021
Accepted: August 30, 2021
Article in press: August 30, 2021
Published online: October 6, 2021

The coronavirus disease 2019 (COVID-19) outbreak has markedly influenced the endoscopic patterns. Endoscopic retrograde cholangiopancreatography (ERCP) is an essential technique for pancreatobiliary disease but increases the risk of exposure to the virus-containing body fluid; however, the impact of COVID-19 on ERCP is unknown.


To compare the number of endoscopic activities and to analyze the clinical outcomes of ERCPs before and during the COVID-19 outbreak in Daegu, South Kore.


This retrospective cohort study included patients aged ≥ 18 years who underwent ERCP between February 18 and March 28, 2020, at a tertiary hospital. ERCP indications and endoscopic details were compared with those from the same period in 2018 and 2019 as control groups.


Of the 269 ERCP procedures, 113 (42.0%) cases were performed as emergency procedures. The number of ERCP procedures in 2018 and 2019 decreased by 20.2% and 56.6%, respectively, compared with that in 2020 (P < 0.01); among the 113 emergency ERCPs, the observed numbers in 2018 (n = 42) and 2019 (n = 55) dramatically dropped by 61.9% and 70.9%, respectively, compared with that in 2020 (n = 16). Of the 16 cases in 2020, stone removal was performed in five, biliary stenting in five, sphincterotomy in five, and nasobiliary drainage in one. No case of ERCP-related infection in medical workers or other patients has been reported.


The COVID-19 outbreak significantly reduced the number of ERCPs; however, there is no difference in the indications and endoscopic interventions before and during the COVID-19 outbreak.

Keywords: Coronavirus disease 2019, Coronavirus, Endoscopic retrograde cholangiopancreatography, Emergency endoscopic retrograde cholangiopancreatography, Endoscopy

Core Tip: The advent of the coronavirus disease 2019 (COVID-19) outbreak has transformed the patterns of endoscopic activities. However, little is known about the clinical impact associated with COVID-19 on endoscopic retrograde cholangiopancreatography (ERCP). We compared the change in the number of ERCP procedures, causes, and clinical outcomes of emergency ERCP before (2018, 2019) and during the COVID-19 (2020) outbreak at a tertiary referral hospital in South Korea.