A0423 - Effects of Gastrointestinal Surgery on Post-ERCP Complications: A National Inpatient Sample Database Analysis

Sunday, October 23, 2022

5:00 PM – 7:00 PM ET

Location: Crown Ballroom

Has Audio

Presenting Author(s)

Vincent Wong, MD

Rutgers New Jersey Medical School
Newark, NJ

Vincent Wong, MD, Anjella Manoharan, MS, MD, Dayna Panchal, DO, Weizheng Wang, MD
Rutgers New Jersey Medical School, Newark, NJ

Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) is a diagnostic and therapeutic tool for pancreaticobiliary diseases. Surgery on the gastrointestinal tract can alter the anatomy and lead to challenges for ERCPs performed. There is currently no data on the association between ERCP complications and post-operative patients with GI tract surgeries.

Methods: The National Inpatient Sample database was used to identify hospitalized patients over 18 years old who had an ERCP procedure between 2007-2017. Patients were divided into two groups: those who had GI tract surgeries and those who did not. Patients were matched by age, race, gender, and the Elixhauser comorbidity index. Primary outcomes were rates of post-ERCP pancreatitis, cholangitis, cholecystitis, infection, hemorrhage, and perforation. The types of GI tract surgeries were then specified to evaluate their rates of complications as secondary outcomes. Multivariate analyses were performed to assess outcomes.

Results: There were 79,335 patients admitted from 2007-2017 who underwent an ERCP procedure and had GI tract surgeries. Primary outcomes were significant (p< 0.05) for post-ERCP pancreatitis (OR 1.3), cholangitis (OR 0.7), infection (OR 1.3), hemorrhage (OR 5.0), and perforation (OR 1.5). Patients were then separated into those who had procedures for an artificial opening which was significant (p< 0.05) for post-ERCP pancreatitis (OR 1.9) and infection (OR 1.4), bariatric surgery which was significant for pancreatitis (OR 1.4), cholangitis (OR 0.3), and perforation (OR 2.3), and those with intestinal bypass and anastomosis which was significant for pancreatitis (OR 0.3), cholangitis (0.5), and infection (0.5).

Discussion: We postulate that the post-operative anatomical changes, type of surgery performed, and equipment limitations can lead to increased risks of post-ERCP pancreatitis, infection, hemorrhage, and perforation. In addition, patients with artificial openings such as gastrostomy tubes have a tract for pathogens that can predispose them to infections. Those with bariatric surgeries have a decrease in post-ERCP cholangitis rates that could be due to the technique used which can minimize bile duct obstruction. Also, the decrease in post-ERCP pancreatitis, cholangitis, and infection in patients with intestinal bypass surgeries may depend on the indication and extent of the bypass surgery. Patients who had GI tract surgeries will need to understand these risks associated with ERCP procedures.

Complication GI Tract Surgeries Artificial Opening Bariatric Surgery Intest.Byp/Anast.

	P-Value	Odds Ratio (95% CI)	P-Value	Odds Ratio (95% CI)	P-Value	Odds Ratio (95% CI)	P-Value	Odds Ratio (95% CI)
Post-ERCP Pancreatitis	0.020	1.3 (1.0-1.7)	0.001	1.9 (1.3-2.8)	0.039	1.4 (1.0-2.0)	0.002	0.3 (0.2-0.7)
Post-ERCP Cholangitis	0.044	0.7 (0.5-1.0)	0.272	1.3 (0.8-2.0)	< 0.001	0.3 (0.1-0.6)	0.027	0.5 (0.3-0.9)
Post-ERCP Cholecystitis	0.397	0.7 (0.4-1.5)	0.997	1.0 (0.3-3.4)	0.958	NS	-	-
Post-ERCP Infection	0.013	1.3 (1.1-1.6)	0.005	1.4 (1.1-1.8)	0.625	1.1 (0.8-1.5)	0.027	0.5 (0.3-0.9)
Post-ERCP Hemorrhage	0.001	5.0 (1.9-13.0)	0.938	1.0 (0.5-2.1)	0.355	0.7 (0.3-1.5)	-	-
Post-ERCP Perforation	0.044	1.5 (1.0-2.3)	0.122	1.7 (0.9-3.1)	0.006	2.3 (1.3-4.3)	-	-

Table: Clinical Outcomes of Patients With all types of Gastrointestinal Tract Surgeries, Artificial Opening, Bariatric surgery, or Intestinal Bypass and Anastomosis, who had Endoscopic Retrograde Cholangiopancreatography (ERCP). CI = Confidence Interval, NS = Not Significant

Disclosures:

Vincent Wong indicated no relevant financial relationships.

Anjella Manoharan indicated no relevant financial relationships.

Dayna Panchal indicated no relevant financial relationships.

Weizheng Wang indicated no relevant financial relationships.

Vincent Wong, MD, Anjella Manoharan, MS, MD, Dayna Panchal, DO, Weizheng Wang, MD. A0423 - Effects of Gastrointestinal Surgery on Post-ERCP Complications: A National Inpatient Sample Database Analysis, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.