B0454 - Endoscopic Retrograde Cholangiopancreatography Adverse Events in Patients With Non-Alcoholic Steatohepatitis

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, Abdul Mohammed, MD³, Juan Reyes Genere, MD⁴, Ahmad Bazarbashi, MD⁴
¹Saint Louis University School of Medicine, St. Louis, MO; ²Tower Health - Reading Hospital, Reading, PA; ³Cleveland Clinic, Cleveland, OH; ⁴Washington University School of Medicine, St. Louis, MO

Introduction: Non-alcoholic steatohepatitis (NASH) is an important manifestation of non-alcoholic fatty liver disease (NAFLD). NASH is characterized by liver inflammation and is associated with the development of fibrosis and cirrhosis. Prior studies have indicated that patients with NAFLD may have an increased risk for post-ERCP pancreatitis (PEP) and mortality. Mechanisms explaining these observations are unclear, but may be related to underlying NASH and associated co-morbidities. We aimed to study the association between NASH and post-ERCP AEs in this context.

Methods: We queried a commercial database (Explorys Inc, Cleveland, OH) with electronic medical record data from 26 major U.S. healthcare systems. Adult patients ( >/=18 years old) with and without NASH 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-squared tests. Odds ratio analyses were performed between NASH and non-NASH patients for post-ERCP AEs within 30 days. Subgroup analysis was performed on patients with NASH without cirrhosis. We defined P-values less than 0.05 to be statistically significant.

Results: A total of 147,320 patients were found to have undergone ERCP. Of those, 1760 (1.2%) had NASH. NASH patients were more likely to be under the age of 65 (49.4% vs 41.6%, P< 0.0001), more likely to be male (43.8% vs 40%, P=0.0315), identified with White race (87.5% vs 78.8%, P< 0.0001) and had a greater likelihood of having cirrhosis (64.8% vs 6.2%, P< 0.0001). NASH patients were more likely to experience same day PEP (OR: 1.23, P=0.0072), sepsis (OR: 1.87, P< 0.0001), gastrointestinal bleeding (GI) (OR: 2.16, P < 0.0001), AKI (OR: 3.37, P< 0.0001), MI (OR: 1.28, P=0.044) and 30-day mortality (OR: 41.6, P< 0.0001). There was no difference in delayed PEP (1-7 days) or intestinal perforation. Subgroup analysis of NASH patients without cirrhosis had an increased likelihood of same day PEP (OR: 1.29, P=0.0425), delayed PEP (OR: 4.41, P< 0.0001), GI bleeding (OR: 1.50, P=0.0306). There was no difference in AKI, sepsis, cholangitis, intestinal perforation and 30-day mortality.

Discussion: This study demonstrates that patients with NASH (with and without cirrhosis) may have a greater chance of experiencing post-ERCP AEs. However, some of these outcomes, particularly mortality, may be driven by an enriched prevalence of cirrhosis amongst those diagnosed with NASH.

Outcome	ERCP in NASH (N=1760)	NASH (%)	ERCP in non-NASH (N=145560)	Non-Nash (%)	P-Value	Odds Ratio	CI (95%)
Post ERCP Pancreatitis < 1d	190	10.8%	13030	9.0%	0.0072	1.2309	1.0577, 1.4324
Post ERCP Pancreatitis 1-7d	60	3.4%	4730	3.2%	0.7076	1.0508	0.8110, 1.3616
30-day mortality	10	0.6%	20	0.01%	< 0.0001	41.5829	19.4359, 88.9660
Sepsis	210	11.9%	9810	6.7%	< 0.0001	1.8748	1.6208, 2.1686
Cholangitis	350	19.9%	33180	22.8%	0.0039	0.8407	0.7474, 0.9457
GI perforation	20	1.1%	1390	1.0%	0.4377	1.1922	0.7648, 1.8584
GI bleed	120	6.8%	4770	3.3%	< 0.0001	2.1597	1.7903, 2.6053
AKI	330	18.8%	9320	6.4%	< 0.0001	3.3734	2.9874, 3.8093
MI	70	4.0%	4560	3.1%	0.0441	1.2808	1.0066, 1.6296

Age
18-65	360	49.4%	60610	41.6%	0.0001
>65	260	51.1%	83110	57.1%	0.0003

Gender
Female	990	56.3%	87270	60.0%	0.0181
Male	770	43.8%	58250	40.0%	0.0315

Race
White	1540	87.5%	114770	78.8%	0.0001
AA	100	5.7%	15210	10.4%	0.1244
Asian	20	1.1%	2160	1.5%	0.8834
Hispanic/Latino	30	1.7%	1740	1.2%	0.8038

Comorbidities
Cerebrovascular disease	330	18.8%	21270	14.6%	0.0323
CAD	560	31.8%	33210	22.8%	< 0.0001
Cardiomyopathy	150	8.5%	7680	5.3%	0.0849
CHF	380	21.6%	19760	13.6%	0.0001
COPD	340	19.3%	25420	17.5%	0.3858
PAD/PVD	870	49.4%	44750	30.7%	< 0.0001
HTN	1460	83.0%	88840	61.0%	< 0.0001
HLD	1240	70.5%	72640	49.9%	< 0.0001
DM	1120	63.6%	44140	30.3%	< 0.0001
CKD	670	38.1%	25390	17.4%	< 0.0001
ESRD	200	11.4%	4580	3.1%	< 0.0001
Presence of cirrhosis	1140	64.8%	9050	6.2%	< 0.0001
Alcohol abuse	170	9.7%	7710	5.3%	0.012
tobacco abuse	360	20.5%	25390	17.4%	0.1238
Obesity	1100	62.5%	36760	25.3%	< 0.0001

Table: Comparison of Post-ERCP Outcomes in Non-Alcoholic Steatohepatitis (NASH) and Non-NASH Patients.

Disclosures:

Ameya Deshmukh indicated no relevant financial relationships.

Parth Desai indicated no relevant financial relationships.

Abdul Mohammed indicated no relevant financial relationships.

Juan Reyes Genere indicated no relevant financial relationships.

Ahmad Bazarbashi indicated no relevant financial relationships.

Ameya Deshmukh, DO¹, Parth Desai, DO², Abdul Mohammed, MD³, Juan Reyes Genere, MD⁴, Ahmad Bazarbashi, MD⁴. B0454 - Endoscopic Retrograde Cholangiopancreatography Adverse Events in Patients With Non-Alcoholic Steatohepatitis, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.