B0455 - Endoscopic Retrograde Cholangiopancreatography Outcomes in Inflammatory Bowel Disease Patients: A 12-Year Analysis of a National Database

Monday, October 24, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Ameya Deshmukh, DO

Saint Louis University School of Medicine
St. Louis, MO

Ameya Deshmukh, DO¹, Parth Desai, DO², Timothy Chrusciel, MPH³, Antonio Cheesman, MD⁴
¹Saint Louis University School of Medicine, St. Louis, MO; ²Tower Health - Reading Hospital, Reading, PA; ³Saint Louis University - Biostatistics Core, St. Louis, MO; ⁴Saint Louis University, St. Louis, MO

Introduction: Inflammatory bowel disease (IBD) patients undergoing ERCP have not been well studied, with few prior studies existing within the current literature with conflicting results. The purpose of this study is to evaluate the impact of IBD on the occurrence of adverse events (AE) relating to ERCP.

Methods: This project utilized the National Inpatient Sample (NIS) database, the largest inpatient database in the United States. All patients 18 years or older with and without IBD undergoing ERCP were identified from 2008 to 2019. Relevant patient characteristics were identified using ICD-9 and ICD-10 codes. Bivariate analyses were conducted using chi-square tests for categorical variables and t-tests for continuous measures. The AEs of interest were pancreatitis, cholecystitis, infection, perforation, gastrointestinal (GI) bleeding, length of stay (LOS), and total inpatient cost. These post-ERCP AEs were analyzed using multivariate logistic or linear regression controlling for age, race, and existing comorbidities using the Charlson comorbidity index (CCI). The primary and secondary diagnoses were used as the procedure indication and the subsequent diagnoses as complications. All analyses accounted for the complex sampling scheme of the NIS. P-values less than 0.05 were considered statistically significant.

Results: 2,013,712 patients had an ERCP from the years 2008 to 2019. Of those, 5993 had IBD. IBD patients undergoing ERCP experienced decreased post-ERCP pancreatitis (PEP) (2.41% vs 3.56%, p=0.0242), GI bleeding (0.24% vs 0.96%, p=0.0093), mortality (0.35% vs 1.47%, p=0.0014), LOS (5.4 vs 6.4 days, p< 0.0001) and inpatient cost ($53,848 vs $70,096, p< 0.0001). There was no significant difference in cholecystitis, infection, or perforation. Adjusted logistic regression indicated that IBD patients remained less likely to experience post-ERCP bleeding (OR: 0.29, p< 0.0001). There was no difference between PEP or mortality after adjusting for covariates.

Discussion: There was no significant difference in PEP or mortality, except for an apparent lower risk of GI bleeding in the IBD group. Multiple factors may have contributed to these findings including significant advances in medical therapy for IBD. Additionally, the association of biliary disease with IBD does not necessarily parallel active intestinal inflammation. This is the largest study evaluating outcomes in IBD patients undergoing ERCP.

	IBD Status
Outcome	Yes (n=5993)	No (n=2,007,719)	p-value
Age	52.6 (0.59)	59.5 (0.13)	< .0001
Race White Black Hispanic Asian or Pacific Islander Native American Other Unknown	4,382 (73.1%) 458 (7.6%) 412 (6.9%) 71 (1.2%) 20 (0.3%) 147 (2.5%) 503 (8.4%)	1,257,759 (62.6%) 169,493 (8.4%) 291,708 (14.5%) 70,233 (3.5%) 12,865 (0.6%) 64,217 (3.2%) 141,445 (7.0%)	< .0001
Gender Female Male	3,244 (54.13%) 2,749 (45.87%)	1,181,239 (58.83%) 825,269 (41.10%)	0.0006
Comorbidity Index	0.9 (0.03)	1.8 (0.01)	< .0001
Pancreatitis	144 (2.41%)	71,381 (3.56%)	0.0242
Cholecystitis	46 (0.76%)	20,878 (1.04%)	0.3501
Infection	388 (6.48%)	147,601 (7.35%)	0.2166
Perforation	6 (0.09%)	1,915 (0.10%)	0.9882
Bleeding	15 (0.24%)	19,369 (0.96%)	0.0093
Mortality during hospitalization	21 (0.35%)	29,580 (1.47%)	0.0014
Length of Stay (mean, SE)	5.4 (0.18)	6.4 (0.03)	< .0001
Total Charges (mean, SE)	$53,848 (2,645.45)	$70,096 (789.21)	< .0001
Adjusted Logistic Regression	Model 1. Pancreatitis	Model 2. Bleeding	Model 3. Mortality
Independent Variable	Odds Ratio (95% CI)	Odds Ratio (95% CI)	Odds Ratio (95% CI)
No IBD	1.38 (0.97-1.96) p=0.0711	3.47 (1.13-10.63) p=0.0297	2.14 (0.81-5.64) p=0.1262
Age at admission	1.00 (1.00-1.00) p< .0001	1.01 (1.01-1.01) p< .0001	1.03 (1.03-1.03) p< .0001
Race White Black Hispanic Asian or Pacific Islander Native American Other Unknown	p< .0001 ref 1.03 (0.96-1.11) 1.45 (1.32-1.58) 1.83 (1.64-2.05) 0.95 (0.75-1.20) 1.13 (1.01-1.26) 0.78 (0.70-0.87)	p< .0001 Ref 1.30 (1.15-1.46) 1.13 (1.01-1.25) 1.91 (1.65-2.21) 1.20 (0.80-1.79) 1.27 (1.06-1.52) 1.17 (1.04-1.33)	p< .0001 Ref 1.39 (1.27-1.51) 0.93 (0.84-1.02) 1.26 (1.11-1.42) 1.28 (0.92-1.79) 1.16 (1.00-1.35) 1.19 (1.06-1.33)
Female Gender	0.99 (0.95-1.02) p=0.4110	0.81 (0.76-0.87) p< .0001	0.85 (0.80-0.89) p< .0001
Comorbidity Index	1.00 (0.99-1.01) p=0.5016	1.04 (1.03-1.05) p< .0001	1.30 (1.29-1.31) p< .0001

Table: Comparison between Post-ERCP Outcomes in Inflammatory Bowel Disease (IBD) and Non-IBD Patients.

Disclosures:

Ameya Deshmukh indicated no relevant financial relationships.

Parth Desai indicated no relevant financial relationships.

Timothy Chrusciel indicated no relevant financial relationships.

Antonio Cheesman indicated no relevant financial relationships.

Ameya Deshmukh, DO¹, Parth Desai, DO², Timothy Chrusciel, MPH³, Antonio Cheesman, MD⁴. B0455 - Endoscopic Retrograde Cholangiopancreatography Outcomes in Inflammatory Bowel Disease Patients: A 12-Year Analysis of a National Database, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.