P3437 - Differential Outcomes of ERCP in Malignant and Benign Biliary Strictures: A National Inpatient Sample Analysis

Gautam Maddineni, MD¹, Akram Ahmad, MBBS², Zaid Ansari, MD³, Silpa Choday, MD⁴, Tilak Upendra. Shah, MD^2
1Florida State University, Cape Coral, FL; ²Cleveland Clinic Florida, Weston, FL; ³Cleveland Clinic Florida, Plantation, FL; ⁴Creighton University School of Medicine, Phoenix, AZ

Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) is essential for managing biliary and pancreatic ductal diseases. Malignant biliary strictures (MS) are often associated with pancreaticobiliary cancers and pose significant challenges. In contrast, benign biliary strictures (BS) result from chronic pancreatitis or post-surgical complications and require accurate differentiation for optimal treatment.

Methods: The research used the National Inpatient Sample database from 2016 to 2019 to compare outcomes of hospitalized adults who underwent ERCP for biliary stricture. We compared outcomes between malignant and benign biliary stricture patients using STATA 18 software and various statistical tests. All descriptive variables were analyzed through both univariate and multivariate analysis, and the results were adjusted for multiple factors, with statistical significance at p < 0.005

Results: Mortality rates were 2,195 (2.63%) for BS and 14,520 (6.78%) for MS, with MS having higher mortality (aOR: 4.07, p< 0.0001). Non-teaching hospitals(NTH) had higher mortality for MS (8.19% vs. 6.53%, p< 0.001), while teaching hospitals(TH) had higher mortality for BS (2.71% vs. 2.25%, p< 0.001).

ERCP for MS accounted for 1.0% (p< 0.001) of cases and 1.68% for BS (p=0.17), with more procedures in TH (67.16%, p=0.17). Post-ERCP infections occurred in 0.15%, higher in MS (0.26%, p=0.3, aOR: 1.85, p=0.25). Bile leaks were 1.21%, higher in BS (3.63%, p=0.007, aOR: 0.63, p=0.002). Pancreatitis occurred in 8.92%, more frequent in BS (10.1%, p=0.004, aOR: 0.8, p=0.009). Hemorrhage occurred in 9.04%, higher in BS (1.94%, p< 0.001, aOR: 0.45, p< 0.001).

The mean length of stay (LOS) was 4.28 days, longer for MS (8.61 days, p< 0.001, adjusted increase of 1.65 days, p< 0.001). Mean total charges were $70,463, higher for MS ($112,537 vs. $89,694, adjusted increase of $18,463, p< 0.001, R²=0.03).

Discussion: The research findings suggest that patients with MS have worse outcomes following ERCP than those with BS. Higher in-hospital mortality rates for MS, especially in NTH, highlight the complexity of managing malignant cases. Additionally, increased post-ERCP infection rates and longer LOS for MS patients emphasize the need for advanced treatment approaches. TH had better outcomes for MS but worse outcomes for BS, suggesting the need for tailored protocols. These findings underscore the critical importance of early diagnosis and specialized care in enhancing ERCP outcomes for patients with MS.



Disclosures:


Gautam Maddineni, MD¹, Akram Ahmad, MBBS², Zaid Ansari, MD³, Silpa Choday, MD⁴, Tilak Upendra. Shah, MD². P3437 - Differential Outcomes of ERCP in Malignant and Benign Biliary Strictures: A National Inpatient Sample Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.