Predictors of postendoscopic retrograde cholangiopancreatography pancreatitis, analysis of more than half a million procedures performed nationwide over the last 15 years

Ali Abbas; Sajiv Sethi; Gitanjali Vidyarthi; Pushpak Taunk

doi:10.1002/jgh3.12341

Predictors of postendoscopic retrograde cholangiopancreatography pancreatitis, analysis of more than half a million procedures performed nationwide over the last 15 years

JGH Open. 2020 Apr 17;4(4):736-742. doi: 10.1002/jgh3.12341. eCollection 2020 Aug.

Authors

Ali Abbas¹, Sajiv Sethi¹, Gitanjali Vidyarthi², Pushpak Taunk³

Affiliations

¹ Section of Gastroenterology USF Health Morsani College of Medicine Tampa Florida USA.
² Section of Gastroenterology James A Haley VA Hospital Tampa Florida USA.
³ Division of Digestive Diseases and Nutrition University of South Florida Morsani College of Medicine Tampa Florida USA.

Abstract

Background and aim: Post-ERCP pancreatitis (PEP) is the most common complication following endoscopic retrograde cholangiopancreatography (ERCP). It is still controversial whether the presence of a trainee would increase the risk of PEP. Additionally, the effects of demographic factors and comorbidities on the risk and severity of PEP are not fully understood. Our aim was to evaluate these factors using national database.

Methods: Nationwide Inpatient Sample 2000-2014 was used to identify adult patients admitted with biliary obstruction without acute pancreatitis and had an inpatient ERCP. PEP was defined as having a subsequent diagnosis of acute pancreatitis. The presence of major organs failure marked moderate-severe PEP. Demographic information, hospital characteristics, and ERCP intervention types were collected.

Results: We included 654 394 patients. Overall PEP rate was 5.4%. The PEP rate was lower in teaching (4.8%) compared with nonteaching (6.2%, P < 0.001) hospitals. The highest PEP rate was observed among patients undergoing Sphincter of Oddi Manometry (15.1%, odds ratio [OR] = 2.5, P < 0.001) as compared to diagnostic cholangiography (4.4%). Asians and Hispanics had higher rate of PEP (10% and 7.9%, respectively) compared with Caucasians and African Americans (4.9% and 5%, respectively, P < 0.001). Multivariate analysis showed that after controlling for the ERCP intervention types, Asians and Hispanics continued to have higher odds of PEP (OR = 1.3, P < 0.001). Seventeen percent of patients were classified as moderate-severe PEP. Older patients (OR = 3.2, P < 0.001), males (OR = 1.4, P < 0.001), and high comorbidities (1.3, P < 0.001) were major predictors of moderate-severe PEP.

Conclusion: No evidence of higher PEP rates in teaching hospitals. Asians and Hispanics had higher PEP rates. Although ERCP intervention type is the major PEP predictor, its severity is dependent on patient characteristics.

Keywords: complications; endoscopic retrograde cholangiopancreatography; epidemiology; health care quality indicators; nationwide; pancreatitis; post‐endoscopic retrograde cholangiopancreatography pancreatitis.