Asian Patients Have Higher Post-ERCP Complications: A Nationwide Analysis of ERCP Safety

Document Type

Conference Proceeding

Publication Date

10-1-2024

Publication Title

Am J Gastroenterol

Abstract

Introduction: In recent years, endoscopic retrograde cholangiopancreatography (ERCP) has evolved into a sophisticated therapeutic intervention. Despite technological advancements, post-procedure complications remain a concern. ERCP entails risks such as bleeding, pancreatitis, perforation, and biliary infections. Identifying risk factors associated with ERCP-related complications is crucial for patient selection and mitigating adverse events. Methods: We utilized the Nationwide Inpatient Sample (NIS) database from 2016 to 2019, including 9764 CKD patients undergoing ERCP. Demographic details and complication incidence were analyzed. Patients were categorized into 5 CKD stages. Those with hematological diseases and cirrhosis were excluded. Results: Patients with Stage 5 CKD were relatively younger, with a mean age of 65.1±13.4 years. End-stage renal disease (ESRD) patients exhibited the highest complication incidence (17.54%), surpassing those with CKD Stages 1, 2, 3, and 4 (14.67%, 12.66%, 12.69%, 13.19%, respectively; P < 0.01). Caucasians constituted the predominant racial group across all CKD stages, accounting for 49.33% in Stage 1, 65.93% in Stage 2, 72.20% in Stage 3, 67.96% in Stage 4, and 46.55% in Stage 5. Compared to Caucasians, Asian patients exhibited the highest risk of post-ERCP complications, with an odds ratio (OR) of 1.0±37 (97.5% confidence interval [CI] = 1.0256-1.1031, P = 0.0009) (Table 1). This group also faced increased risks of death (OR = 1.0203, 97.5% CI = 1.0102-1.0412, P = 0.0415) and cholecystitis (OR = 1.0307, 97.5% CI = 1.0026-1.0596, P = 0.0321). However, no statistically significant differences were observed for infection, bleeding, and pancreatitis (P > 0.05). African Americans exhibited a higher risk of cholecystitis (OR = 1.018) but lower risks of pancreatitis (OR = 0.9862) and bleeding (OR = 0.993). Native Americans had a lower incidence of infection (OR = 0.9895). Conclusion: Asians exhibited elevated post-ERCP complications possibly due to higher biliary tract pathology incidences. Variations in complications among racial groups may be related to genetic or environmental factors. The NIS database's overrepresentation of Caucasians warrants caution in generalizing findings. Increased communication with ethnic minority patients and further studies are crucial for better understanding these differences. (Table Presented).

Volume

119

Issue

10

First Page

S1148

Last Page

S1149

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