ERCP in Obese Patients: A Retrospective Analysis of Efficacy and Safety

Abstract

Purpose: Endoscopic retrograde cholangiopancreatography (ERCP) is a widely used diagnostic and therapeutic procedure in the management of pancreato-biliary diseases. It is well documented that the incidence of gallstone disease is increased in obese patients hence an increased demand for ERCP in this patient population. The aim of this study is to compare the efficacy and safety of ERCP in obese patients versus non-obese patients. Methods: We retrospectively reviewed all consecutive ERCP cases performed in Bronx-Lebanon Hospital from January 2007-November 2010. We sequentially compared the endoscopic records of obese patients (BMI ≥ 30) and nonobese patients (BMI < 30) in the study period. The primary outcome measures were indications, cannulation success rate, ERCP findings, interventions, periprocedure respiratory or cardiac complications and post-ERCP complications. Results: A total of 220 ERCP procedures were performed out of which 76 cases were performed in obese patients compared to 144 in non-obese patients. The mean age was 48.4 in the obese group and 42.1 in the non-obese group while the mean BMI was 36.8 and 25.3 in obese and non-obese patients respectively. The cannulation success rate was lower in the obese patients (81.5% vs 94% P = 0.01). The most common indication for ERCP was suspected CBD stones in both groups (82% in obese patients vs 66% in non-obese patients). Peri-procedure cardiac or respiratory complications were similar in both groups and post-procedure complications including pancreatitis (6.5% vs 7.6% P = 0.809), perforation (1.32% vs 0% P = 0.782) and bleeding (0% vs 2.1% P = 0.463) were not significantly different in the obese group versus the non-obese group. Conclusion: Obese patients carry similar risks of post-ERCP complications and peri-procedure cardiac or respiratory complications as non-obese patients. However, the cannulation success rate was lower in this group of patients compared to non-obese patients.