Predictors of Inpatient Hospital Pancreatitis in CKD Patients Undergoing ERCP: A Comprehensive National Analysis

Document Type

Conference Proceeding

Publication Date

10-1-2024

Publication Title

Am J Gastroenterol

Abstract

Introduction: Despite advancements in endoscopic technology, post-ERCP complications persist as significant concerns. Identifying the risk factors associated with ERCP-related complications is crucial for judicious patient selection and targeted strategies to mitigate adverse events. Conducting endoscopic procedures in individuals with renal dysfunction carries a heightened susceptibility to complications. However, scant literature exists elucidating the adverse event profile of ERCP in CKD and ESRD populations. Methods: We conducted a comprehensive national dataset analysis to evaluate the clinical outcomes and safety parameters associated with ERCP in CKD and ESRD patients. This study compared the incidence of pancreatitis among different CKD stages (n=9,764). A secondary aim was to delineate the risk factors contributing to postprocedural adverse events in this patient cohort. Results: Post-ERCP pancreatitis (PEP) was significantly higher in the ESRD group (4.57%) compared to Stage 1 CKD (1.33%) with adjusted OR (aOR) = 1.03 (97.5% CI: 1.0002-1.06, P < 0.048). Pancreatic procedures carried a higher risk for PEP than biliary procedures (OR = 1.0299, 97.5% CI: 1.0172-1.0429, P < 0.0001). PEP was not associated with age, sex, type of hospital, or most comorbidities (COPD, PUD, DM, HTN, PVD, CVA) (P > 0.05). However, a higher incidence of PEP was associated with AMI (OR = 1.0322, 97.5% CI 1.005-1.060, P = 0.022), CHF (OR = 1.0118, 97.5% CI 1.0028-1.021, P = 0.0104), and malignancy (OR = 1.0218, 97.5% CI 1.0105-1.0331, P = 0.0001). Conclusion: The incidence of PEP is significantly higher in patients with ESRD compared to patients with stage 1 CKD. Pancreatic procedures pose a higher risk for PEP than biliary procedures. PEP was not associated with age, sex, type of hospital, or most comorbidities, but was higher in patients with AMI, CHF, and malignancy. The increasing correlation between ESRD and PEP could be explained by fluid overload-induced papillary edema, making biliary cannulation difficult. Another mechanism is the higher occurrence of gallstones caused by elevated bile cholesterol levels and disruptions in the autonomic nervous system due to uremia, leading to cholestasis. These findings underscore the importance of careful patient selection and risk stratification in CKD and ESRD patients undergoing ERCP to mitigate the risk of PEP. (Table Presented).

Volume

119

Issue

10

First Page

S1149

Last Page

S1150

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