A0419 - Outcomes of Endoscopic Retrograde Cholangiopancreatography in Patients With Inflammatory Bowel Disease: A Nationwide Study

Sunday, October 23, 2022

5:00 PM – 7:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

MK

Markos Kalligeros, MD

Brown University
Providence, RI

Markos Kalligeros, MD¹, Paul Kröner, MD, MS², Francis A. Farraye, MD, MSc³, Athanasios Desalermos, MD⁴
¹Brown University, Providence, RI; ²Mayo Clinic Florida, Jacksonville, FL; ³Mayo Clinic, Jacksonville, FL; ⁴University of Massachusetts, Leominster, MA

Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) has become a commonly utilized procedure for both diagnostic and therapeutic purposes. There is a paucity of data for patients with inflammatory bowel disease (IBD) who undergo ERCP. The aim of this study is to examine potential complications, costs and inpatient outcomes of patients with IBD undergoing ERCP.

Methods: For this retrospective-cohort study we utilized the National Inpatient Sample database for the years 2018-2019. We compared potential indications, outcomes, ERCP-related procedures, and resource utilization in patients who underwent ERCP and had a diagnosis of IBD to that of patients who underwent ERCP without a diagnosis of IBD. We utilized a multivariate regression model that accounted for several potential confounders.

Results: We identified 318,590 ERCP procedures. Among them, 3,625 ERCP procedures were performed in patients with an associated diagnosis of IBD. Patients with IBD who underwent ERCP had higher odds of acute kidney injury (aOR 1.27; 95% CI: 1.01-1.60) and sepsis (aOR 1.33; 95% CI: 1.07-1.67) compared to patients without IBD (Table 1). However, inpatient mortality and other complications were not statistically different between the two groups. Patients with IBD were also less likely to undergo biliary sphincterotomy (aOR 0.75; 95% CI: 0.62- 0.88) but there were no other differences in performance of ERCP-related therapeutic interventions between the two groups. Adjusted costs and charges were not statistically different between the two groups.

Discussion: The use of ERCP in patients with IBD was examined. Patients who underwent ERCP with and without a diagnosis of IBD did not display differences in inpatient mortality or in ERCP-related complications. However, patients with IBD did display higher odds and rates of non-PSC cholangitis, as well as higher rates of obstructive choledocholithiasis when compared to patients without IBD. This study provides basic data on the inpatient ERCP outcomes in patients with and without IBD. Future prospective studies are needed to clearly establish the association and causality between IBD disease activity and patient outcomes. In addition, this data should be compared to that of outpatient ERCP in patients with IBD.

	IBD combined	Crohn’s	Ulcerative Colitis
	aOR (95% CI)	aOR (95% CI)	aOR (95% CI)
ERCP related procedures
Bile duct stenting	1.16 (0.98-1.36)	1.19 (0.96-1.48)	1.30 (1.04-1.63)
Pancreatic duct Stenting	1.25 (0.99-1.58)	1.26 (0.94-1.70)	1.11 (0.81-1.52)
Biliary Sphincterotomy	0.75 (0.62-0.88)	0.71 (0.57-0.89)	0.76 (0.60-0.95)
Pancreatic Sphincterotomy	1.88 (0.28-12.7)	Not enough data	3.10 (0.44-22.08)
Biliary ductal dilation	1.25 (0.95-1.65)	1.53 (1.09-2.15)	1.34 (0.93-1.92)
Pancreatic duct dilation	1.34 (0.50-3.63)	1.76 (0.56-5.56)	1.13 (0.28-4.56)
Ampullectomy	1.23 (0.17-9.13)	Not enough data	2.01 (0.27-14.77)
Complications
Mortality	0.99 (0.49-2.02)	0.67 (0.21-2.11)	1.01 (0.41-2.46)
Shock	1.24 (0.85-1.79)	1.12 (0.66-1.88)	1.48 (0.96-2.29)
Acute kidney injury	1.27 (1.01-1.60)	1.30 (0.96-1.75)	1.38 (1.02-1.85)
Sepsis	1.33 (1.07-1.67)	1.25 (0.94-1.68)	1.69 (1.28-2.23)
Multiorgan failure	1.24 (0.99-1.54)	1.17 (0.87-1.56)	1.37 (1.04-1.81)
Post ERCP pancreatitis	0.99 (0.80-1.24)	1.09 (0.82-1.44)	0.76 (0.55-1.04)
Bile duct perforation	1.73 (0.65-4.64)	3.04 (1.13-8.16)	0.72 (0.10-5.18)
Post-procedural bleeding	1.03 (0.87-1.31)	Not enough data	Not enough data
aOR: Adjusted odds ratio; CI: Confidence interval; ERCP: endoscopic retrograde cholangiopancreatography

Table: Odds of complications and ERCP-related procedures in patients who underwent ERCP comparing patients with and without IBD

Disclosures:

Markos Kalligeros indicated no relevant financial relationships.

Paul Kröner indicated no relevant financial relationships.

Francis Farraye: Adiso Therapeutics – DSMB. BMS – Advisory Committee/Board Member. Braintree Labs – Advisory Committee/Board Member. GSK – Advisory Committee/Board Member. IBD Educational Group – Advisory Committee/Board Member. Innovation Pharmaceuticals – Stock Options. Iterative Scopes – Advisory Committee/Board Member. Janssen – Advisory Committee/Board Member. Lilly – DSMB. Pfizer – Advisory Committee/Board Member. Sebela – Advisory Committee/Board Member. Theravance – DSMB.

Athanasios Desalermos indicated no relevant financial relationships.

Markos Kalligeros, MD¹, Paul Kröner, MD, MS², Francis A. Farraye, MD, MSc³, Athanasios Desalermos, MD⁴. A0419 - Outcomes of Endoscopic Retrograde Cholangiopancreatography in Patients With Inflammatory Bowel Disease: A Nationwide Study, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.