S0928 ERCP for Gallstone Pancreatitis in Fluid Sensitive Patients Is Associated With Increased Rates of Volume Overload Without Increased Rates of Post-ERCP Pancreatitis

Abstract

INTRODUCTION: While endoscopic retrograde cholangiopancreatography (ERCP) plays a vital role in contemporary clinical care, post-ERCP pancreatitis is a frequent and serious complication of this therapeutic procedure. Several clinical trials have shown that aggressive fluid resuscitation may decrease post-ERCP pancreatitis. However, these trials excluded patients with renal disease, heart failure, and cirrhosis. Thus fluid management in this group following ERCP is unclear. METHODS: The National Inpatient Sample (NIS) for years 2015 quarter 4, 2016, and 2017 was queried for overlapping ICD10 diagnosis codes for biliary pancreatitis and ICD10 procedure codes for ERCP. The complications of post-ERCP pancreatitis and volume overload were determined by searching for ICD10 codes for pancreatitis and overload that were not in the first two diagnosis codes. Logistic regression and multiple linear regression analyses were used. RESULTS: In patients who underwent ERCP for gallstone pancreatitis, CHF, ESRD, and cirrhosis were associated with post-ERCP pancreatitis at the same rates as their respective counterparts. However, CHF and cirrhosis was associated with symptoms of overload more often—2.7 times as often for patients with CHF (95% CI 2.1–3.3), and 3.3 times as often for patients with cirrhosis (95% CI 2.3–5.1). In patients with ESRD, the rate of overload approached statistical significance as well (OR = 1.2, 95% CI 0.9–1.6). Furthermore, CHF and ESRD was associated with increased length of hospital stays (CHF = 2.1 additional days from the mean, P < 0.01; ESRD = 0.9 additional days, P < 0.01) and cost of hospitalization (CHF = $13,326 from mean, P < 0.01; ESRD = $11,084 from mean, P < 0.01). CHF was also associated with mortality at 2.1 times the rate (95% CI 1.1–4.0) while ESRD was associated with mortality at 2.0 times the rate (95% CI 1.0–3.8). CONCLUSION: In patients who underwent ERCP for management of biliary stones, the rates of post-ERCP pancreatitis were similar in patients with and without CHF, ESRD, and cirrhosis. However, CHF and cirrhosis were associated with symptoms of volume overload, prolonged hospitalization, and increased mortality. Thus hydration in these patients following ERCP should be used with caution.Table 1.: Multivariate analysis of post-ERCP outcomes and complications by comorbidity. CHF = congestive heart failure, ESRD = end stage renal disease, ERCP = endoscopic retrograde cholangiopancreatography, LOS = length of stay