Introduction: Endoscopic Retrograde Cholangiopancreatography(ERCP) is challenging in patients with Roux-en-Y(Rxy) gastric bypass, however, it remains a cornerstone intervention for these patients when develop biliary obstruction. We used the Nationwide Inpatient Sample (NIS)data to study biliary obstruction/cholangitis in Rxy and ERCP outcomes.
Methods: The NIS database for 2016-17 was queried for biliary obstruction(ICD10:K831), cholangitis(K830), Rxy status(Z98.84). Outcomes were compared between cases with/without Rxy and those undergoing ERCP vs percut. drainage. We used chi-square test for categorical variables, independent-sample-T-test for LOS/cost, and performed multivariable-logistic-regression, adjusted for age, sex, race, income, hepato-pancreato-biliary malignancy, hospital location and teaching status, region, and DRG-based severity of illness subclass. 2-sided p< 0.05 is considered significant
Results: A total 286,905 cases with biliary obstruction were found, among which 94,445 (33%) had cholangitis and 3,705 (1.3%) had Rxy bypass. Overall rate of percut-drainage was significantly higher in patients with Rxy bypass (6.5% vs. 4.2%, p< 0.01). Overall adjusted-mortality was lower in Rxy (2.3% vs. 4.9%, aOR: 0.537, 95%CI:0.429 to 0.671,p< 0.01).
In Rxy-group (3705), 32.5%(1205) underwent ERCP, and 6.5%(240) underwent percutaneous-drainage. Mortality in Rxy patients undergoing ERCP was lower (1.1% vs. 3.0%) compared to those without ERCP.
Patients undergoing ERCP had lower hospital costs and LOS(6.8 vs. 12.1 days,p< 0.01; $20,413 vs. $35,602, p< 0.01). In subgroup analysis with Rxy bypass, differences were less profound but still notable (6.7 vs. 7.9 days,p=0.01; $19,900 vs. $22,411, p=0.08).
Subgroup analysis for cholangitis showed that 1.7% (1,565) had Rxy bypass. Mortality was significantly lower in the Rxy (1.6% vs. 6.5%, OR: 0.333, 95% CI: 0.222 to 0.499, p< 0.01). ERCP in cholangitis patients with Rxy was associated with shorter LOS and lower costs(7.4 vs. 9.1 days, p=0.02; $20,667 vs. $28,626, p=0.01).
Discussion: Our study found a notable burden of hospitalization due to biliary obstruction/cholangitis in Rxy, which has high mortality and healthcare utilization. Despite being a technically challenging intervention, ERCP is associated with decreased LOS & cost of care, leading to reduced healthcare utilization. Further studies are needed to understand these associations better.
Figure: Table 1-4
Disclosures:
Mohamed Tausif Siddiqui indicated no relevant financial relationships.
Zehra Naseem indicated no relevant financial relationships.
Hassan Siddiki: Boston Scientific consulting – Consultant.
Mohamed Tausif Siddiqui, MD1, Zehra Naseem, MD2, Hassan Siddiki, MD1. P2767 - Biliary Obstruction Management in Roux-en-Y Bypass and ERCP: A Study on Clinical Outcomes and Healthcare Resource Utilization, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
