Predictors of Post ERCP Pancreatitis: Analysis of More Than Half a Million ERCPs Performed Nationwide over the Last 15 Years

Introduction: Post ERCP Pancreatitis (PEP) is the most common complication following ERCP with a reported rate of 2-5%. Major predictors of PEP include the type of intervention performed during ERCP. However, it is unknown if demographic factors such as race and ethnicity could increase the risk of PEP. Our aim was to identify such demographic factors after controlling for the type of intervention during ERCP. Methods: We used the Nationwide Inpatient Sample (NIS) for the years 2000-2014. Adults patients, who were admitted with biliary obstruction without acute pancreatitis based on the record’s primary and secondary diagnosis and had an inpatient ERCP, were identified using ICD9 codes. PEP was defined as having a subsequent diagnosis of acute pancreatitis. Moderate to severe PEP was identified by the presence of codes for organ failure. ERCP was classified by intervention (diagnostic, biliary, pancreatic, and both). Demographic information on age, gender, race, insurance status and geographic region was collected. Comorbidities were summarized by the Charlson comorbidity index. Rates of PEP were calculated and compared across the investigated predictor. Multivariate logistic analysis was used to identify independent predictors of PEP. Results: A total of 654,394 patients with median age of 59 years, and 66% females. Overall PEP rate was 5.4%. Asians and Hispanics had a higher rate of PEP (10% and 7.9% respectively) compared to Caucasians and African Americans (4.9% and 5% respectively, p<0.001). Patients who had both biliary and pancreatic interventions had a higher rate of PEP (8.3%) compared to diagnostic ERCPs (4.5%, p <0.001). PEP rates varied significantly across the type of ERCP intervention (Figure). Multivariate analysis showed that after controlling for the ERCP intervention, Asians and Hispanics continued to have higher odds of PEP. Although rural hospitals had the lowest PEP rate (4.2%), multivariate analysis after adjusting for the level of ERCP intervention showed that patients who were admitted to urban-teaching hospitals had the lowest odds of developing PEP (OR 0.9, p<0.001), (Table). Conclusion: In this nationwide study, patients of Asian and Hispanic race had significantly higher rates of developing PEP after controlling for other demographic, hospital, and the classic procedure related risk factors. More research should be directed to elucidate the genetic role in susceptibility to develop PEP.57_A Figure 1. Rate of PEP by ERCP Intervention. SOD: sphincter of oddi. PD: pancreatic duct. ERP: endoscopic retrograde pancreaticography. BD: bile duct. ERC: endoscopic retrograde cholangiography.57_B Figure 2. No Caption available.