ANALYZING TRENDS AND PATTERNS IN ERCP-RELATED ADVERSE EVENTS: WHERE WE NEED TO DO BETTER

Document Type

Conference Proceeding

Publication Date

6-1-2024

Publication Title

Gastrointest Endosc

Abstract

Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive procedure that has evolved from primarily diagnostic to predominantly therapeutic, leading to an increased potential for ERCP-related adverse events. The most frequent adverse events associated with ERCP are pancreatitis, perforation, and hemorrhage. Previous literature suggests a rise in post-ERCP pancreatitis (PEP). With an emphasis on quality metrics in healthcare models, it becomes crucial to identify contemporary trends of adverse events to implement appropriate prophylactic measures. Our longitudinal study examines temporal trends in common ERCP-related adverse events. Methods: We used the National Readmission Database (2016-2020) and employed International Classification of Diseases (ICD)-10 codes to sample adult patients who underwent ERCP. Linear trends were studied for ERCP-related adverse events using the Mantel-Haenszel linear trend test after adjusting for age, gender, procedure volume, and comorbidities. Adverse event rates were calculated per 1000 ERCPs performed. We used Stata, version 14.2, to perform analyses, considering 2-sided P< 0.05 as statistically significant. Results: The analysis included data on 850,459 ERCPs (mean age 60.57 years, 56.76% females). The incidence of PEP increased from 11.17/1000 in 2016 to 17.27/1000 in 2020 (trend P<0.01, Figure 1). However, rates of post-sphincterotomy bleeding decreased from 7.24/1000 to 5.25/1000 during the study period (trend P=0.02). Bile duct perforation, though infrequent, exhibited a slight upward trend from 0.56 cases per 1000 to 1.75 cases per 1000 (trend P<0.01). The rates of duodenal perforation and post-ERCP cholecystitis were consistently low and exhibited no significant change over the study duration (trend P>0.05). Discussion: Despite advancements in cannulation techniques and enhanced prophylactic measures against PEP, our investigation, aligned with existing literature on PEP, indicates a consistent rise in its incidence over the last decade. This can be ascribed to advances in interventional techniques and the ever-evolving therapeutic potential of ERCP, as reflected in concurrent, albeit slight, rise in bile duct perforation rates. Notably, our study observed a decline in the rate of post-sphincterotomy bleeding, contrasting with prior literature and highlighting improved periendoscopic management of antiplatelets and anticoagulants. Nonetheless, given the rising PEP incidence, our findings underscores the necessity of identifying patients at risk and strict guideline adherence to employ preventive measures against it.

Volume

99

Issue

6

First Page

AB671

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