Temporal Trends and Mortality of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis in the United States: A Nationwide Analysis

Link to article at PubMed

Endoscopy. 2020 Jul 15. doi: 10.1055/a-1220-2242. Online ahead of print.


BACKGROUND AND STUDY AIMS: Post-ERCP pancreatitis (PEP) is the most common and serious complication of ERCPs. Our aim was to estimate the nationwide incidence, temporal trends and mortality of PEP and establish its risk-factors in the United States.

METHODS: This was a retrospective cohort study analyzing the Nationwide Inpatient Sample (NIS) data from 2011 to 2017 using ICD codes. The primary outcomes were to assess the trends of post-ERCP pancreatitis (PEP) and the predictors of occurrence of PEP. Secondary outcomes were in-hospital mortality, length of stay and ICU admission.

RESULTS: Of the 1,222,467 adult patients who underwent inpatient ERCP during the study period, 55,225 (4.5%) developed post-ERCP pancreatitis. The hospital admission rate of PEP increased by 13.3% from 7,735 in 2011 to 8,920 in 2017 (OR 1.23, 95% CI 1.04-1.46; p = 0.016). The overall rate of mortality increased from 2.75% of PEP cases in 2011 to 4.38% in 2017 (OR: 1.62, 95% CI 1.10-2.38, p = 0.014). Multiple patient-related (alcohol use, cocaine use, obesity, chronic kidney disease, heart failure), procedure-related (therapeutic ERCP, sphincterotomy, pancreatic duct stent placement, sphincter of Oddi dysfunction) and hospital-related factors (teaching hospitals, hospitals located in West and Mid-west) that impact the occurrence of PEP were identified.

CONCLUSIONS: Our study shows a rising hospital admission rate and mortality associated with PEP in the United States. This calls for a greater recognition of this life-threatening complication and amelioration of its risk-factors, whenever possible.

PMID:32668463 | DOI:10.1055/a-1220-2242

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