Skip to main content

Advertisement

SpringerLink
Log in

Endoscopic retrograde cholangiopancreatography outcomes in inflammatory bowel disease patients: a 12-year analysis of a national database

  • RESEARCH
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

Despite inflammatory bowel disease’s (IBD) association with hepatobiliary disorders and the use of endoscopic retrograde cholangiopancreatography (ERCP) for both diagnostic and therapeutic evaluation of these diseases, it remains a poorly studied area within the literature. The purpose of this study is to examine the effect of IBD on the occurrence of adverse events (AE) pertaining to ERCP.

Methods

This project utilized the National Inpatient Sample (NIS) database, the largest inpatient database in the USA. All patients 18 years or older with and without IBD undergoing ERCP were identified from 2008 to 2019. Post-ERCP AEs were analyzed using multivariate logistic or linear regression controlling for age, race, and existing comorbidities using the Charlson comorbidity index (CCI).

Results

There was no difference in post-ERCP pancreatitis (PEP) or mortality. IBD patients were also found to have a lower risk of bleeding and decreased length of stay (LOS) despite adjustment for comorbidities. They also underwent less sphincterotomies when compared to the non-IBD cohort. Subgroup analysis between ulcerative colitis (UC) and Crohn’s disease (CD) did not find any significant differences in outcomes.

Conclusion

To our knowledge, this is the largest study to date evaluating ERCP outcomes in IBD patients. After adjustment of co-variates, there was no difference in the occurrence of PEP, infections, and perforation. IBD patients were less likely to experience post-ERCP bleeding and mortality and had shorter LOS which may be due to the decreased frequency of sphincterotomy in this population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data availability

This study retrieved data from the National Inpatient Sample (NIS) which is publicly available. It is managed by the Agency for Healthcare Research and Quality (AHRQ) and holds information regarding the representative sample of hospitalizations within the United States. This project used data from the years 2008 to 2019 and is available from the AHRQ website.

References

  1. Kochar B, Akshintala VS, Afghani E et al (2015) Incidence, severity, and mortality of post-ERCP pancreatitis: a systematic review by using randomized, controlled trials. Gastrointest Endosc 81(1):143–149.e9. https://doi.org/10.1016/j.gie.2014.06.045

    Article  PubMed  Google Scholar 

  2. ASGE Standards of Practice Committee, Chandrasekhara V, Khashab MA et al (2017) Adverse events associated with ERCP. Gastrointest Endosc 85(1):32–47. https://doi.org/10.1016/j.gie.2016.06.051

  3. Elmunzer BJ, Scheiman JM, Lehman GA et al (2012) A randomized trial of rectal indomethacin to prevent post-ERCP pancreatitis. N Engl J Med 366(15):1414–1422. https://doi.org/10.1056/NEJMoa1111103

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Tse F, Yuan Y, Moayyedi P, Leontiadis GI (2013) Guide wire-assisted cannulation for the prevention of post-ERCP pancreatitis: a systematic review and meta-analysis. Endoscopy 45(8):605–618. https://doi.org/10.1055/s-0032-1326640

    Article  CAS  PubMed  Google Scholar 

  5. Venkatesh PG, Navaneethan U, Shen B (2011) Hepatobiliary disorders and complications of inflammatory bowel disease. J Dig Dis 12(4):245–256

    Article  PubMed  Google Scholar 

  6. Sawas T, Asfari MM, Cho WK (2017) Endoscopic retrograde cholangiopancreatography is safe in inflammatory bowel disease: 864. Official Journal of the American College of Gastroenterology 112:S488–S489

  7. Ghavimi S, Hashemipour R, Azimi H, Choi C, Nasir UM, Ahlawat S (2020) Su1586 Outcomes of endoscopic retrograde cholangiopancreatography in patients with inflammatory bowel disease. Gastrointest Endo 91(6):AB390

  8. Asfari MM, Perry I, Sarmini MT, Masood M, Frazier H, Hamid O, Sridhar S, Sifuentes H (2022) Measure twice, cut once: appraising the safety of ERCP in IBD. Japanese J Gstro Hepato 8(7):1–6

    Google Scholar 

  9. (HCUP) HNISNHCaUP (2018–2019) Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/nisoverview.jsp 

  10. Shen B, Kochhar G, Navaneethan U et al (2019) Role of interventional inflammatory bowel disease in the era of biologic therapy: a position statement from the Global Interventional IBD Group. Gastrointest Endosc 89(2):215–237. https://doi.org/10.1016/j.gie.2018.09.045

    Article  PubMed  Google Scholar 

  11. Pekgöz M (2019) Post-endoscopic retrograde cholangiopancreatography pancreatitis: a systematic review for prevention and treatment. World J Gastroenterol 25(29):4019–4042. https://doi.org/10.3748/wjg.v25.i29.4019

    Article  PubMed  PubMed Central  Google Scholar 

  12. Mutneja HR, Vohra I, Go A et al (2021) Temporal trends and mortality of post-ERCP pancreatitis in the United States: a nationwide analysis. Endoscopy 53(4):357–366. https://doi.org/10.1055/a-1220-2242

    Article  PubMed  Google Scholar 

  13. Easler JJ, Fogel EL (2021) Prevention of post-ERCP pancreatitis: the search continues. Lancet Gastroenterol Hepatol 6(5):336–337. https://doi.org/10.1016/S2468-1253(21)00063-7

    Article  PubMed  PubMed Central  Google Scholar 

  14. Tse F, Yuan Y, Moayyedi P, Leontiadis GI (2013) Guide wire-assisted cannulation for the prevention of post-ERCP pancreatitis: a systematic review and meta-analysis. Endoscopy 45(8):605–618. https://doi.org/10.1055/s-0032-1326640

    Article  CAS  PubMed  Google Scholar 

  15. Haber CJ, Meltzer SJ, Present DH, Korelitz BI (1986) Nature and course of pancreatitis caused by 6-mercaptopurine in the treatment of inflammatory bowel disease. Gastroenterology 91(4):982–986. https://doi.org/10.1016/0016-5085(86)90703-1

    Article  CAS  PubMed  Google Scholar 

  16. Loperfido S, Angelini G, Benedetti G et al (1998) Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study. Gastrointest Endosc 48(1):1–10. https://doi.org/10.1016/s0016-5107(98)70121-x

    Article  CAS  PubMed  Google Scholar 

  17. Leung WK, But DY, Wong SY et al (2018) Prevention of post-sphincterotomy bleeding by proton pump inhibitor: a randomized controlled trial. J Dig Dis 19(6):369–376. https://doi.org/10.1111/1751-2980.12604

    Article  CAS  PubMed  Google Scholar 

  18. Wilcox CM, Canakis J, Mönkemüller KE, Bondora AW, Geels W (2004) Patterns of bleeding after endoscopic sphincterotomy, the subsequent risk of bleeding, and the role of epinephrine injection. Am J Gastroenterol 99(2):244–248. https://doi.org/10.1111/j.1572-0241.2004.04058.x

    Article  PubMed  Google Scholar 

  19. Ferreira LE, Baron TH (2007) Post-sphincterotomy bleeding: who, what, when, and how. Am J Gastroenterol 102(12):2850–2858. https://doi.org/10.1111/j.1572-0241.2007.01563.x

    Article  PubMed  Google Scholar 

  20. Canena J, Liberato M, Horta D, Romão C, Coutinho A (2013) Short-term stenting using fully covered self-expandable metal stents for treatment of refractory biliary leaks, postsphincterotomy bleeding, and perforations. Surg Endosc 27(1):313–324. https://doi.org/10.1007/s00464-012-2368-3

    Article  PubMed  Google Scholar 

  21. Du M, Suo J, Liu B, Xing Y, Chen L, Liu Y (2017) Post-ERCP infection and its epidemiological and clinical characteristics in a large Chinese tertiary hospital: a 4-year surveillance study. Antimicrob Resist Infect Control 6:131. Published 2017 Dec 29. https://doi.org/10.1186/s13756-017-0290-0

  22. Argollo M, Gilardi D, Peyrin-Biroulet C, Chabot JF, Peyrin-Biroulet L, Danese S (2019) Comorbidities in inflammatory bowel disease: a call for action. Lancet Gastroenterol Hepatol 4(8):643–654. https://doi.org/10.1016/S2468-1253(19)30173-6

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Saint Louis University - SOM, 1201 South Grand Boulevard, St. Louis, MO, 63104, USA

    Ameya Deshmukh, Eugene Nwankwo & Rohan Tripathi

  2. Division of Gastroenterology and Hepatology, Reading Hospital – Tower Health, PA, Reading, USA

    Parth M. Desai

  3. Advanced Health Data Research Institute (AHEAD), Saint Louis University, St. Louis, MO, USA

    Timothy Chrusciel

  4. Division of Gastroenterology and Hepatology, Saint Louis University – SOM, St. Louis, MO, USA

    Antonio R. Cheesman

Authors
  1. Ameya Deshmukh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Parth M. Desai
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Timothy Chrusciel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eugene Nwankwo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rohan Tripathi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Antonio R. Cheesman
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Study concept and design by Ameya Deshmukh and Antonio Cheesman; acquisition of data by Timothy Chrusciel; analysis and interpretation of data by Timothy Chrusciel, Ameya Deshmukh, and Antonio Cheesman; drafting of the manuscript by Ameya Deshmukh, Parth Desai, Timothy Chrusciel, Eugene Nwankwo, Rohan Tripathi, and Antonio Cheesman; and critical revision of the manuscript for important intellectual content by Ameya Deshmukh, Parth Desai, Timothy Chrusciel, Eugene Nwankwo, and Antonio Cheesman.

Corresponding author

Correspondence to Ameya Deshmukh.

Ethics declarations

Ethics approval and consent to participate

This study was granted IRB-exempt status, and informed consent was waived by the Institutional Review Board at Saint Louis University.

Conflict of interest

The authors declare no competing interests.

Additional information

Communicated by Christoph-Thomas Germer.

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 16 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Deshmukh, A., Desai, P.M., Chrusciel, T. et al. Endoscopic retrograde cholangiopancreatography outcomes in inflammatory bowel disease patients: a 12-year analysis of a national database. Int J Colorectal Dis 38, 137 (2023). https://doi.org/10.1007/s00384-023-04427-4

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00384-023-04427-4

Keywords

Search

Navigation