Su1568 OUTCOMES OF ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY IN PATIENTS WITH CHOLANGIOCARCINOMA – A NATIONAL DATABASE STUDY

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) is the standard of care for diagnosing and treating biliary ductal complications, particularly in patients who have diagnosed cholangiocarcinoma. However, there is limited data on complications associated with ERCP in patients with cholangiocarcinoma. The aim of this study was to examine the outcomes associated with ERCP in patients with cholangiocarcinoma when compared to the general population. The NIS database from the years 2008-2012 was used to identify all patients ≥ 18 years of age who underwent ERCP. The patient population and controls were selected based on coding in accordance with the ICD-9 CM. The control population was selected among non-cholangiocarcinoma patients who underwent ERCP by using stratified sampling in which four non-cholangiocarcinoma patients were matched randomly for every cholangiocarcinoma patient. The outcomes evaluated were ERCP-related adverse events – pancreatitis, bleeding, infection, perforation, and biliary obstruction. Secondary outcomes were demographics, length of stay, hospital costs, and comorbidities. Statistical analysis was performed using chi-squared tests for categorical data and t test for continuous data. Multivariable logistic regression was used to assess the association between post-ERCP biliary obstruction and cholangiocarcinoma patients while adjusting for confounding variables. All statistical analysis was performed using IBM SPSS software. A P value of ≤ 0.05 represents statistical significance. There was a total of 4847 discharges in NIS 2008-2012 with cholangiocarcinoma patients who underwent ERCP. Patients in the cholangiocarcinoma group were mostly male, had more admissions to teaching and large hospitals, and had greater comorbidity as determined by Elixhauser index (Table 1). Bivariate analysis showed patients with cholangiocarcinoma were more likely to undergo biliary sphincterotomy and stent placement (49.1% vs 27.8%, p <0.01) when compared to control group. ERCP associated biliary obstruction (2.1% vs 0.9%, p<0.01) and in-patient mortality (3.8 vs 2.2) was higher in cholangiocarcinoma patients when compared to controls (Table 2). Multivariable analysis showed the presence of cholangiocarcinoma (aOR 1.96, p<0.01) independently increased the risk of post-ERCP biliary obstruction. In this large national study, we establish that patients with cholangiocarcinoma when compared to the general population have a higher risk of post-ERCP associated biliary obstruction. Interestingly, patients with cholangiocarcinoma have lower risk of post-ERCP pancreatitis and hemorrhage. It is unclear if the increase in-patient mortality is associated with higher comorbidities in patient with cholangiocarcinoma, however it is unlikely to be directly related to post-procedural complications.View Large Image Figure ViewerDownload Hi-res image Download (PPT)