E0022 - Adverse Events Following ERCP Are Higher in Patients With Chronic Pancreatitis

Tuesday, October 25, 2022

3:00 PM – 5:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Parth Desai, DO

Tower Health - Reading Hospital
Reading, PA

Parth Desai, DO¹, Abdul Mohammed, MD², Ameya Deshmukh, DO³, Madhusudhan Sanaka, MD⁴
¹Tower Health - Reading Hospital, Reading, PA; ²Cleveland Clinic, Cleveland, OH; ³Saint Louis University School of Medicine, St. Louis, MO; ⁴Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH

Introduction: Endoscopy retrograde cholangiopancreatography (ERCP) is frequently used to manage complications of chronic pancreatitis (CP) including pancreatic duct stones, strictures, and leaks. Previous studies have indicated a protective effect of chronic pancreatitis on rates and severity of post-ERCP pancreatitis. The aim of this study was to evaluate the risk of adverse events (AEs) in a large national cohort of patients with chronic pancreatitis who underwent ERCP.

Methods: We queried the Explorys database (Cleveland, OH), comprised of electronic medical record data from 26 major U.S. healthcare systems. Adult patients, 18 years of age and older, with and without CP who underwent ERCP between 1999 and 2021 were identified based on systematized nomenclature of medicine-Clinical Terms (SNOMED-CT). Differences in baseline characteristics and demographics were analyzed using chi-square tests. Odds ratio analyses were performed between CP and non-CP patients for AEs within 30 days of ERCP. We considered P-values less than 0.05 to be statistically significant.

Results: Out of total of 147,360 patients who underwent ERCP, we identified 13,270 (9%) patients with CP. Patients with CP who underwent ERCP were more likely male (47.9% vs. 39.3%, P< 0.0001) and African American (16.3% vs. 9.8%, P< 0.0001). CP patients had higher rates of chronic obstructive pulmonary disease (27.5% vs. 16.7%, P< 0.0001), diabetes mellitus (46.0% vs. 29.2%, P< 0.0001), alcohol abuse (19.2% vs. 4.0%, p< 0.0001), and tobacco abuse (35.9% vs. 16.2%). CP patients compared to non-CP patients had higher odds of adverse events within 30 days of ERCP including mortality (OR 5.06, P< 0.0001), sepsis (OR 1.14, P< 0.0001), AKI (1.20, P< 0.0001), gastrointestinal bleeding (OR 1.35, P< 0.0001), and myocardial infarction (OR 1.36, P< 0.0001). The odds of acute pancreatitis within 7 days were also higher (OR 2.32, P< 0.0001). The odds of cholangitis within 30 days were lower in the CP group (0.48, P< 0.0001).

Discussion: Compared to non-CP patients, CP patients had higher odds of post-ERCP AEs. Contrary to prior data, rates of acute pancreatitis after ERCP were higher in the CP group. Differences in AEs may be related to altered biliary and pancreatic ductal anatomy, pancreatic reserve, and comorbid conditions stemming from higher rates of tobacco and alcohol use in CP patients. Further studies are warranted to help clarify these associations and stratify the safety of ERCP in CP patients.

Outcome	ERCP + Chronic Pancreatitis (n=13,270), n	ERCP + CP, %	ERCP + No CP (n=134,090), n	ERCP + No CP, %	Odds Ratio	CI (95%)	P-Value
Mortality*	10	0.1%	20	0.0%	5.0562	2.3662, 10.8041	< 0.0001
Sepsis*	1,040	7.8%	8,970	6.7%	1.1441	1.0702, 1.2230	< 0.0001
Cholangitis*	1,780	13.4%	31,760	23.7%	0.4803	0.4563, 0.5056	< 0.0001
AKI*	1,040	7.8%	8,610	6.4%	1.1953	1.1180, 1.2780	< 0.0001
GI bleed*	590	4.4%	4,310	3.2%	1.3531	1.2392, 1.4774	< 0.0001
Acute pancreatitis (1-7 days)	890	6.7%	3,900	2.9%	2.3157	2.1483, 2.4961	< 0.0001
MI*	560	4.2%	4,070	3.0%	1.3594	1.2422, 1.4876	< 0.0001

Gender
Female	6,910	52.1%	81,370	60.7%			< 0.0001
Male	6,350	47.9%	52,690	39.3%			< 0.0001

Race
White	10,110	76.2%	106,210	79.2%			< 0.0001
African American	2,160	16.3%	13,160	9.8%			< 0.0001
Asian	140	1.1%	2,040	1.5%			0.7041
Hispanic/Latino	120	0.9%	1,650	1.2%			0.7689

Age
Adults (18-65y)	7,110	53.6%	77,960	58.1%			0.0001
Seniors ( >65y)	6,090	45.9%	54,340	40.5%			0.0001

Comorbidities
Stroke	2,300	17.3%	19,310	14.4%			0.0002
CAD	3,490	26.3%	30,290	22.6%			< 0.0001
Cardiomyopathy	910	6.9%	6,920	5.2%			0.0329
CHF	1,990	15.0%	18,150	13.5%			0.0643
COPD	3,410	25.7%	22,350	16.7%			< 0.0001
PAD/PVD	5,060	38.1%	40,560	30.2%			< 0.0001
HTN	9,350	70.5%	80,980	60.4%			< 0.0001
HLD	7,480	56.4%	66,430	49.5%			< 0.0001
DM	6,100	46.0%	39,170	29.2%			< 0.0001
CKD	2,920	22.0%	23,140	17.3%			< 0.0001
ESRD	740	5.6%	4,040	3.0%			0.0003
Cirrhosis	1,540	11.6%	8,660	6.5%			< 0.0001
Alcohol abuse	2,550	19.2%	5,330	4.0%			< 0.0001
Tobacco abuse	4,760	35.9%	21,660	16.2%			< 0.0001
Obesity	3,360	25.3%	34,510	25.7%			0.612

Table: *Within 30 days of ERCP

Disclosures:

Parth Desai indicated no relevant financial relationships.

Abdul Mohammed indicated no relevant financial relationships.

Ameya Deshmukh indicated no relevant financial relationships.

Madhusudhan Sanaka indicated no relevant financial relationships.

Parth Desai, DO¹, Abdul Mohammed, MD², Ameya Deshmukh, DO³, Madhusudhan Sanaka, MD⁴. E0022 - Adverse Events Following ERCP Are Higher in Patients With Chronic Pancreatitis, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.