Surgeon-Performed Endoscopic Retrograde Cholangiopancreatography in a Rural Trinidad Hospital: A 10-Year Review of Practice and Outcomes.

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) is a key therapeutic modality for biliary and pancreatic diseases. While outcomes from tertiary centres are well documented, there is limited published data describing ERCP practice in Caribbean settings. This study evaluated the patient characteristics, indications, procedural outcomes, and complications of surgeon-performed ERCPs at a rural hospital in Trinidad. METHODS: A retrospective observational study was conducted of all patients who underwent attempted or completed ERCP between 1 January 2015 and 31 December 2025, performed by general surgeons at a rural hospital in eastern Trinidad. Patients with incomplete records or abandoned procedures before cannulation were excluded. Demographic characteristics, indications, procedural findings, therapeutic interventions, technical success, procedure failures, and 30-day complications were extracted from operative records and medical files. Continuous variables were summarised using medians with interquartile ranges (IQRs), while categorical variables were reported as frequencies and percentages. RESULTS: Seventy-nine ERCPs performed in 75 patients were analysed. Median age was 54.0 (IQR: 36-67) years, consisting of 52 females (69.3%) and 23 males (30.7%). Choledocholithiasis was the predominant indication. Deep biliary cannulation was achieved in 83.5% of procedures. Stones were identified in 54 patients and successfully extracted in 51 of those (94.4%). Therapeutic intervention was performed in 84.8% of procedures, with stone extraction (64.6%) and sphincterotomy (58.2%) being the most common interventions. Thirteen procedures (16.5%) were unsuccessful, primarily due to failed cannulation, inadequate sedation, or intra-operative desaturation. Thirty-day complications occurred in 21.5% of procedures, the most common being mild post-ERCP pancreatitis (15.2%). Bleeding occurred in 3.8%, cardiopulmonary complications in 2.5%, and cholangitis in 1.3%. No perforations or procedure-related mortality was identified. CONCLUSION: Surgeon-performed ERCP in a rural Caribbean hospital is safe and effective in this specific rural setting when performed by trained surgeons with appropriate support, with technical success and complication rates approaching British Society of Gastroenterology benchmarks, though below the European Society of Gastrointestinal Endoscopy's 90% target. The predominance of therapeutic procedures, high stone clearance rate, and the absence of procedure-related mortality suggest feasibility of decentralisation of advanced endoscopic services in a resource-limited Caribbean setting, pending further multi-centre validation. These findings provide one of the first benchmarks for surgeon-performed ERCP outcomes in the English-speaking Caribbean.