P1183 - Endoscopic Retrograde Cholangiopancreatography (ERCP) in Patients With Liver Cirrhosis: National Inpatient Study of Prevalence and Outcomes

Anwar Uddin, MD, Madia Ahad, MD, Rafat Uddin, BA, Rahat Uddin, MS, Afgal Ahad, MD
SUNY Downstate Medical Center, Brooklyn, NY

Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) is a valuable diagnostic and therapeutic tool for patients with liver cirrhosis (LC), often used to manage complications such as biliary obstruction and pancreatitis. This study aimed to evaluate the trend and outcomes of ERCP in patients with liver cirrhosis using the nationwide database.

Methods: We used the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) to identify adult patients with liver cirrhosis during 2016 – 2020 using ICD-10-CM codes. We used ICD-10-PCS codes to identify patients who had ERCP procedure. Main outcomes were in-hospital mortality, length of stay (LOS), and hospital costs and we also examined secondary outcomes for ERCP complications including pancreatitis, bile duct perforation, cholangitis, iatrogenic pneumothorax, post-ERCP pain, ERCP-associated infection, and cholecystitis. We evaluated the association between CDI and outcomes using survey based multivariate logistic regression models for in-hospital mortality and secondary outcomes, Poisson regression for LOS, and generalized linear model with gamma distribution and log link for hospitalization cost. Models were adjusted for age, sex, race and ethnicity, primary payer, Charlson comorbidity index, hospital bed size, hospital region and hospital teaching status.

Results: We identified a total of 3,648,794 liver cirrhosis hospitalizations between 2016 and 2020 in the United States and 30,605 (0.84%) of them had ERCP procedure with significant increasing trend of ERCP rate across discharge year (0.79% in 2016 to 0.88% in 2020, p = 0.005). LC patients with ERCP had significantly lower in-patient mortality compared to those without ERCP (3.8% vs 5.9%, adjusted OR: 0.62, 95%CI: 0.54 – 0.70, P < 0.001, Table 1). LC patients with ERCP had an increased length of stay (9.4 ± 0.16 vs 6.1 ± 0.02 days, P < 0.001) and an increased cost of hospitalization ($37,271 ± 1,028 vs $17,880 ± 111, P < 0.001, Table 1). ERCP related complications pancreatitis, bile duct perforation, cholangitis, pain, infection and cholecystitis were significantly higher in LC patients with ERCP compared to those without ERCP (P < 0.001, Table 1).

Discussion: ERCP procedure is frequent among LC patients and associated with higher complications, length of stay, and hospitalization cost but lower in-hospital mortality .


Disclosures:


Anwar Uddin, MD, Madia Ahad, MD, Rafat Uddin, BA, Rahat Uddin, MS, Afgal Ahad, MD. P1183 - Endoscopic Retrograde Cholangiopancreatography (ERCP) in Patients With Liver Cirrhosis: National Inpatient Study of Prevalence and Outcomes, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.