Sarah Meribout, MD1, Anis L. Meribout, MD2, Ahmed E. Salem, MBBCh1, Carla Barberan Parraga, MD3, Kamal Hassan, MD4, Syed Mujtaba Baqir, MD1, Mohammed Abusuliman, MD5, Islam B Mohamed, MD6, Aaron Z. Tokayer, MD, MHS, FACG1, Anthony Kalloo, MD7 1Maimonides Medical Center, Brooklyn, NY; 2University of Constantine 3, Abu Dhabi, Abu Dhabi, United Arab Emirates; 3Maimonides Medical Center, New York, NY; 4New York-Presbyterian/Queens, New York, NY; 5Henry Ford Health, Detroit, MI; 6Cleveland Clinic Foundation, Cleveland, OH; 7Johns Hopkins University School of Medicine, Baltimore, MD
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).
Discussion: 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.
Note: The table for this abstract can be viewed in the ePoster Gallery section of the ACG 2024 ePoster Site or in The American Journal of Gastroenterology's abstract supplement issue, both of which will be available starting October 27, 2024.
Disclosures:
Sarah Meribout indicated no relevant financial relationships.
Anis Meribout indicated no relevant financial relationships.
Ahmed Salem indicated no relevant financial relationships.
Carla Barberan Parraga indicated no relevant financial relationships.
Kamal Hassan indicated no relevant financial relationships.
Syed Mujtaba Baqir indicated no relevant financial relationships.
Mohammed Abusuliman indicated no relevant financial relationships.
Islam B Mohamed indicated no relevant financial relationships.
Aaron Tokayer indicated no relevant financial relationships.
Anthony Kalloo: Colowrap – Advisory Committee/Board Member, Owner/Ownership Interest. GI Scientific – Advisor or Review Panel Member, Owner/Ownership Interest.
Sarah Meribout, MD1, Anis L. Meribout, MD2, Ahmed E. Salem, MBBCh1, Carla Barberan Parraga, MD3, Kamal Hassan, MD4, Syed Mujtaba Baqir, MD1, Mohammed Abusuliman, MD5, Islam B Mohamed, MD6, Aaron Z. Tokayer, MD, MHS, FACG1, Anthony Kalloo, MD7. P2770 - Predictors of Inpatient Hospital Pancreatitis in CKD Patients Undergoing ERCP: A Comprehensive National Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
