Retrospective Study Assessing Incidence of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis Following a Negative Study to Assess for a Method of Prevention

Abstract

Introduction: Endoscopic retrograde cholangiopancreatogram (ERCP) has long been considered the gold-standard in the diagnosis and treatment of choledocholithiasis (CDL). However post-ERCP pancreatitis is the most common and severe complication associated with this procedure and carries significant morbidity with increased hospital costs. We piloted a retrospective analysis to identify the incidence of post-ERCP pancreatitis in patients with negative ERCPs and to determine if additional screening should be implemented in a subset of patients. Methods: This was a retrospective single-centered study. All ERCPs performed for CDL were reviewed from 2015-2017. Only negative studies were included. Patients were then pre-operatively risk stratified into low, intermediate, or high risk for CDL based upon pre-op bilirubin and abdominal ultrasound results. Development of post-ERCP pancreatitis, pre-ERCP labs (total bilirubin, AST, AST, alkaline phosphatase), and demographics were recorded. Results: A total of 287 ERCPs were performed from August 2015 through August 2017 for CDL, 37 of which were negative (12.9%). Of the negative studies, 10 (27.0%) patients were categorized as having low-risk, 21 (56.8%) as intermediate risk, and six (16.2%) as high-risk. Three patients developed post-ERCP pancreatitis. No statistical difference in patient demographics and pre-ERCP labs between patients who developed post-ERCP pancreatitis and those who did not. Conclusion: Post-ERCP pancreatitis is an unfortunate complication which carries a significant burden both to the patient and hospital system. Fortunately within our study population, only a small number of patients developed this complication. We were unable to identify any statistically significant pre-ERCP risk for its development. However, we did discover a negative ERCP rate of 12.9% for CDL, with over 84% of cases having a low or indeterminate pre-ERCP risk for CDL. Thus, raising the clinical suspicion that additional screening should be performed in these subset of patients such as pre-EUS screening. Additional studies are required to identify the cost-effectiveness of implementing such protocols.