Temporal trends and mortality of post-ERCP pancreatitis in the United States: a nationwide analysis

Abstract

BACKGROUND AND STUDY AIMS: Post-ERCP pancreatitis (PEP) is the most common and serious complication of ERCPs. Our aim was to estimate the nationwide incidence, temporal trends and mortality of PEP and establish its risk-factors in the United States. METHODS: This was a retrospective cohort study analyzing the Nationwide Inpatient Sample (NIS) data from 2011 to 2017 using ICD codes. The primary outcomes were to assess the trends of post-ERCP pancreatitis (PEP) and the predictors of occurrence of PEP. Secondary outcomes were in-hospital mortality, length of stay and ICU admission. RESULTS: Of the 1,222,467 adult patients who underwent inpatient ERCP during the study period, 55,225 (4.5%) developed post-ERCP pancreatitis. The hospital admission rate of PEP increased by 13.3% from 7,735 in 2011 to 8,920 in 2017 (OR 1.23, 95% CI 1.04-1.46; p = 0.016). The overall rate of mortality increased from 2.75% of PEP cases in 2011 to 4.38% in 2017 (OR: 1.62, 95% CI 1.10-2.38, p = 0.014). Multiple patient-related (alcohol use, cocaine use, obesity, chronic kidney disease, heart failure), procedure-related (therapeutic ERCP, sphincterotomy, pancreatic duct stent placement, sphincter of Oddi dysfunction) and hospital-related factors (teaching hospitals, hospitals located in West and Mid-west) that impact the occurrence of PEP were identified. CONCLUSIONS: Our study shows a rising hospital admission rate and mortality associated with PEP in the United States. This calls for a greater recognition of this life-threatening complication and amelioration of its risk-factors, whenever possible.

Endoscopic retrograde cholangiopancreatography‐related adverse events in Korea: A nationwide assessment

“…Rectal non‐steroidal anti‐inflammatory drugs have not been available in Korea until now. A recent cohort study from the US also showed a rising admission rate and mortality associated with PEP 10 . This trend of increasing PEP is probably due to the recent attempts to more complex cases.…”

“…However, it does not contain all information on ERCP in Sweden, and there may be input errors. The same is true for databases in the US 10 or Australia 14,15 . In the case of the US database, 10 it is difficult to say that it is representative of the situation of the whole country because it was sample data.…”

Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis: An Updated Review of Current Preventive Strategies

“…This study also demonstrated upward trends in hospitalization rates (increased by 13.3% from 2011 to 2017) as well as mortality rates related to PEP (2.75% in 2011 to 4.38% of PEP cases in 2017). 4…”

Adverse events associated with endoscopic retrograde cholangiopancreatography: protocol for a systematic review and meta-analysis

“…[11][12][13] Despite an emphasis on training and quality, both the incidence of PEP and its associated mortality are rising in the USA. 14 Rates of post-ERCP bleeding range between 0.3% and 2%. [15][16][17] Symptomatic post-ERCP infection (cholangitis with or without sepsis) is also a common AE following ERCP, with a reported range between 0.5% and 3%, 11 and is of particular interest in recent years given the rise of duodenoscope-related infections.…”