Su1450 OUTCOMES OF ERCP IN PATIENTS WITH ACUTE STROKE: A NATIONAL STUDY

Abstract

There is limited data on the safety of endoscopic retrograde cholangiopancreatography (ERCP) in patients with recent acute stroke. The objective of this study is to better assess safety and outcomes in patients with admission for acute stroke that undergo ERCP for a variety of reasons during the same admission in a national inpatient database. The National Inpatient Sample (NIS) is the largest all-payer inpatient database in the United States. Data from the years 2008 to 2014 were collected. Patients older than 18 years with an admission diagnosis of acute stroke (ischemic or hemorrhagic) and who underwent ERCP were included. Case-control matching (2:1) for patients that underwent ERCP but did not have acute stroke was done based on age and sex. Complications related to the ERCP were measured against these case controls. Limitations of the study are that the NIS is an administrative database which predisposes to errors from coding inaccuracies as well as the inability to distinguish temporal relationships between variables. Between 2008 and 2014, there were 562 patients older than 18 years with acute stroke who underwent inpatient ERCP during the same hospital admission. Baseline patient demographics and hospital characteristics is available in Table 1. Complications related to ERCP occurred more frequently in the stroke group (13.8% vs. 8.7%, p=0.001). The rate of post-ERCP pancreatitis (10.4% vs. 7.4%, p=0.04) as well as post-ERCP bleeding (2.5% vs. 1.2%, p=0.07) was higher in the stroke group compared to the control. The risk of bleeding was not statistically different between groups however. This is outlined in Table 3.The primary indication for ERCP in patients with acute stroke was biliary stricture while that in the control group was biliary pancreatitis (Table 2). Although overall complications are higher in the acute stroke setting, ERCP can be performed when indicated. Caution should be exercised to avoid or minimize complications such as risks of post-ERCP pancreatitis and bleeding. Prospective randomized controlled studies are needed to better define the timing of the ERCP in this setting.View Large Image Figure ViewerDownload Hi-res image Download (PPT)