Robert Wood Johnson Medical School, Rutgers University Franklin Park, NJ
Savan Kabaria, MD1, Anish V. Patel, MD2, Abhishek Bhurwal, MD2; 1Robert Wood Johnson Medical School, Rutgers University, Franklin Park, NJ; 2Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ
Introduction: Endoscopic Retrograde Cholangiopancreatography (ERCP) is recommended within 24 hours for patients with Acute biliary pancreatitis (ABP) with signs of cholangitis. In the absence of cholangitis, the impact of the timing of ERCP remains unclear. We aimed to analyze the timing of ERCP in ABP patients without cholangitis. Methods: This is a retrospective, longitudinal study of patients from 2005 to 2014, who presented to the US hospitals with diagnosis of ABP and received ERCP within first 24 hours (urgent ERCP) or within 24 to 72 hours (early ERCP). Study cohort was extracted from the Nationwide Inpatient Sample database. Hospital ERCP volumes were generated using unique hospital identifiers. Multivariate regression modeling was used to analyze the predictors of urgent vs. early ERCP use, and to determine various outcome variables between the two cohort. Results: Overall, 105,433 admissions were evaluated. There was a significant p-trend (p < 0.001) increase in urgent ERCP performed over the 10-year study period (Figure 1). Predictors of urgent ERCP in ABP patients utilizing multivariate regression model are shown in Figure 2. Older patients, males, patients with comorbidities, African American and Hispanic patient population were significantly less likely to receive ERCP urgently. Intermediate ERCP volume hospitals were more likely to perform urgent ERCP in ABP patients. Additionally, teaching hospitals and hospitals in the Midwest and West were more likely to perform urgent ERCP. Use of abdominal imaging modalities prior to ERCP resulted in 50% decrease in the utilization of urgent ERCP. There were no differences in mortality rates or the complications rates between the two cohorts (Table 1). The composite variable encompassing all the complications was not significant between the two groups. There were significant differences in length of stay and healthcare cost analysis. Discussion: We performed a retrospective study of patients with ABP (but without cholangitis) that showed an increasing trend of urgent ERCP over the study period without clinically significant benefit in mortality, length of stay and healthcare cost analysis. Further, urgent ERCP utilization is not uniform across various demographic and hospital cohorts. Hence, early ERCP may be over-utilized, and it may be reasonable to perform early ERCP (within 24-72 hours) instead of urgent ERCP in ABP patients in the absence of cholangitis.
Figure 1: Trends of urgent ERCP utilization in Acute Biliary Pancreatitis patients without signs of cholangitis across a 10-year period from 2005 to 2014
Figure 2: Multivariate regression model predicting demographic and hospital factors affecting urgent ERCP utilization in Acute Biliary Pancreatitis without signs of cholangitis.
Table 1: Mutivariate Hazard Ratios and Regression Coefficients of various outcome factors based on patients receiving urgent ERCP in Acute Biliary Pancreatitis patients without signs of cholangitis compared to patients receiving early ERCP
Disclosures: Savan Kabaria indicated no relevant financial relationships. Anish Patel indicated no relevant financial relationships. Abhishek Bhurwal indicated no relevant financial relationships.