Outcomes Of Endoscopic Retrograde Cholangiopancreatography Research Articles

Safety of Nonagenarians Receiving Therapeutic ERCP, Single Center Experience.

(1) Background: The complication rates for nonagenarians receiving therapeutic endoscopic retrograde cholangiopancreatography (ERCP) remain poorly understood. We aimed to determine whether nonagenarians were at an increased risk of ERCP-related complications. (2) Methods: We performed a retrospective study on therapeutic ERCP in nonagenarians from 2011 to 2016 at Taichung Veterans General Hospital. A control group comprising patients aged 65 to 89 years was used to compare demographic data and the outcomes of therapeutic ERCP with the nonagenarians. The risk factors for complications were determined by logistic regression model. (3) Results: There were 35 nonagenarians and 111 patients in the control group. Overall, complication rates were not statistically different between the two groups. However, advanced age was an independent predictor of complications in the multivariate analysis (odds ratio [OR] = 1.06; 95% confidence interval [CI] = 1.01–1.12; p = 0.049). End stage renal disease (ESRD) was another independent predictor of complications (OR = 4.87; 95% CI = 1.11–21.36; p = 0.036). Post-ERCP pancreatitis and bleeding were more common in ESRD patients than patients without ESRD. (4) Conclusions: Although nonagenarians receiving ERCP did not have more complications compared to elderly patients younger than 90 years, advanced age and comorbidity still affect the outcome of therapeutic ERCP in the elderly patients.

Risk prediction of common bile duct stone recurrence based on new common bile duct morphological subtypes.

Stones in the common bile duct (CBD) are reported worldwide, and this condition is majorly managed through endoscopic retrograde cholangiopancreatography (ERCP). CBD stone recurrence is an important issue after endoscopic stone removal. Therefore, it is essential to identify its risk factors to determine the necessity of regular follow-up in patients who underwent endoscopic removal of CBD stones. The authors identified that the S and polyline morphological subtypes of CBD were associated with increased stone recurrence. New morphological subtypes of CBD presented by the authors can be important risk predictors of recurrence after endoscopic stone removal. Furthermore, the new morphological subtypes of CBD may predict the risk of residual CBD stones or technical difficulty in CBD stone removal. Further studies with a large sample size and longer follow-up durations are warranted to examine the usefulness of the newly identified morphological subtypes of CBD in predicting the outcomes of ERCP for CBD stone removal.

Outcomes and predictors of response to endotherapy in pancreatic ductal disruptions with refractory internal and high-output external fistulae.

Endoscopic retrograde cholangiopancreatography (ERCP) remains the primary treatment for a subset of patients with pancreatic fistulae. The objective of this study was reporting outcomes of ERCP and predictors of resolution in patients with pancreatic fistulae refractory to conservative therapy. Retrospective review of patients who underwent ERCP and pancreatic stent placement for pancreatic fistula not responding to medical therapy was performed. Clinical features, laboratory parameters, radiological features and pancreatogram findings were noted. Clinical resolution of fistula was the primary outcome measure. Sixty-eight patients underwent ERCP for high-output pancreatic fistula (Mean age 34.1 years, 91.1% males, 35/68 chronic pancreatitis, 52.9% alcohol etiology). Internal fistulae (pancreatic ascites, pleural effusion, or pericardial effusion) were seen in 55 (80.9%) patients and external fistula in 13 (19.1%) patients. Technical success for ERCP was 92.6% (63/68). Leak was seen in 98.4% (62/63). The most common leak site was body (69.8%). Multiple leak sites were seen in 23.1%. Pancreatic stricture was found in 36.5%. In 44 (69.4%) patients, stent was placed beyond the site of the leak. Resolution at six weeks was achieved in 76.4% (52/68). On univariate and multivariate analyses, placement of stent beyond site of leak was significantly associated with resolution of high-output fistulae (3/41 [7.3%] vs. 5/19 [26.3%], p = 0.03; odds ratio: 6.5, 95% confidence interval: 1.211-34.94). In our experience, ERCP was successful in 76% of patients with pancreatic fistulae refractory to conservative therapy. Stent placement beyond the site of leak was associated with higher resolution of fistulae.

Outcome of primary ERCP versus primary PTC for biliary drainage in malignant hilar biliary strictures: a systematic review and meta-analysis.

Patients with malignant hilar biliary strictures can suffer from obstructive jaundice. Controversy remains on the optimal approach to obtain preoperative or palliative biliary drainage in these patients. A systematic review and meta-analysis was conducted to compare the two modalities most commonly used in this scenario: endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC). MEDLINE via PubMed was searched for relevant articles published from 2005 to April 2019. Following outcome measures were used to compare ERCP and PTC: therapeutic success rate, cholangitis, pancreatitis, bleeding,tube dislocation, reintervention rate, mortality such as 30d mortality and in-hospital death, median survival time, drainage patency, duration until decompression and hospital stay. Risk of bias assessment for the retrospective studies was conducted by NOS. RoB 2 was used for RCT. A meta-analysis was performed by using Review Manager 5.3. The certainty of evidence was appraised using GRADE. Eleven articles of which one RCT and ten retrospective cohort studies fulfilled the inclusion criteria for data-analysis (1417 patients; 784 ERCP, 633 PTC). The combined odds ratio (OR) for therapeutic succes was 3.5 times higher in the PTC group (95% CI 2.05-5.97; high certainty). In terms of cholangitis, ERCP carried a 1.7-fold risk as compared to PTC (95% CI 0.92-3.08; moderate certainty). Patients who underwent ERCP were 11.50 times more likely to undergo a reintervention (95% CI 3.51-37.70; moderate certainty). ERCP was comparable to PTC in terms of pancreatitis (low certainty), bleeding (high certainty) and tube dislocation rate (moderate certainty). Mortality tended to be numerically higher in the PTC group but low patient numbers, selection bias and study heterogeneity did not allow uniform comparative analysis. In patients with malignant hilar biliary strictures, PTC is associated with a better therapeutic success rate, less cholangitis and lower reintervention rate as compared to ERCP.

Malnutrition Is Associated With Worse Outcomes of Inpatient Endoscopic Retrograde Cholangiopancreatography.

ObjectivesEndoscopic retrograde cholangiopancreatography (ERCP) is frequently used to manage pancreaticobiliary disorders in an inpatient setting. Malnutrition is prevalent among hospitalized patients, and it is generally associated with poor clinical outcomes. However, there is a lack of studies on how malnutrition affects the outcomes of inpatient ERCP. Thus, we investigated the outcomes of inpatient ERCP among patients with malnutrition.MethodsAdult patients who underwent ERCP from the 2014 National Inpatient Sample database were selected to conduct retrospective analysis. Patient demographics and outcomes of ERCP were compared between the groups with and without malnutrition. The outcomes of interest were inpatient mortality, length of stay, total hospital charge, and ERCP complications, including pancreatitis, cholecystitis, cholangitis, sepsis, hemorrhage, and intestinal perforation.ResultsPatients with malnutrition had longer length of stay (15.5 days vs. 6.7 days, p < 0.05) and higher total hospital charge ($149,699 vs. $71,723, p < 0.05). Malnutrition was an independent risk factor for inpatient mortality (adjusted odds ratio (aOR) 2.54, 95% confidence interval (CI): 1.70-3.82, p < 0.05), sepsis (aOR 2.20, 95% CI: 1.82-2.65, p < 0.05), hemorrhage (aOR 1.64, 95% CI: 1.05-2.56, p < 0.05), and intestinal perforation (aOR 4.29, 95% Cl:1.61-11.46, p < 0.05).ConclusionsOur study indicates that patients with malnutrition are more likely to have worse outcomes, such as increased inpatient mortality, sepsis, hemorrhage, and intestinal perforation. Understanding the nutrition status of patients undergoing ERCP can be a useful approach for risk stratification and determining if closer surveillance of the complications is warranted.

A retrospective analysis of outcome of endoscopic management in choledocholithiasis in a tertiary care centre

Background: The role of endoscopic retrograde cholangiopancreatography (ERCP) as a therapeutic intervention for choledocholithiasis is long established. Endoscopic therapy involves stone extraction using conventional methods after performing endoscopic biliary sphincterotomy. The objective of this study was to determine the outcome of patients with choledocholithiasis being treated in our setup.Methods: This retrospective observational study was conducted at T.N.M.C. and BYL Nair Hospital, Mumbai from January 2017 to October 2017. All patients with choledocholithiasis proven radiologically were admitted. All patients underwent elective endoscopic retrograde cholangiopancreatography. In patients in whom ERCP failed, open surgical clearance of the common bile duct was done.Results: A total of 50 cases of choledocholithiasis were admitted during the study period. Age distribution in our study was from 27 years to 81 years of which, 46% were males and 54% were females. Successful clearance of CBD with balloon sweep, dormia basket, CBD stenting or sphincterotomy alone was done in 38 patients (76%). Nine patients (18%) required repeat ERCP/ more than one sitting for clearance of CBD. Most of the patients had stone size of &gt;10 mm (8 out of 9 patients i.e. 88.89%). Three patients were referred for surgical intervention due to non-retrieval of calculus. All these patients had stone size &gt;15 mm (100%).Conclusions: In our study 94% patients eventually achieved successful clearance with ERCP. Also, the size of the stone was an independent risk factor that affected the outcome of ERCP.

Urgent Endoscopic Retrograde Cholangiopancreatography (ERCP) vs. Conventional Approach in Acute Biliary Pancreatitis Without Cholangitis: An Updated Systematic Review and Meta-Analysis.

Gallstone disease is the common cause of acute pancreatitis. The role of early endoscopic retrograde cholangiopancreatography (ERCP) in biliary pancreatitis without cholangitis is not well-established. Thus, this study aims to compare the outcome of early ERCP with conservative management in patients with acute biliary pancreatitis without acute cholangitis. An online search of PubMed, PubMed Central, Embase, Scopus, and Clinicaltrials.gov databases was performed for relevant studies published till December 15, 2020. Statistical analysis was performed using RevMan v 5.4 (The Nordic Cochrane Centre, Cochrane Collaboration, Copenhagen). Odds Ratio (OR) with a 95% confidence interval was used for outcome estimation. Among 2700 studies from the database search, we included four studies in the final analysis. Pooling of data showed no significant reduction in mortality (OR 0.59, 95% CI 0.32 to 1.09; p=0.09); overall complications (OR 0.56, 95% CI 0.30 to 1.01; p=0.05); new-onset organ failure (OR 1.06, 95% CI 0.65 to 1.75; p=0.81); pancreatic necrosis (OR 0.80, 95% CI 0.49 to 1.32; p=0.38); pancreatic pseudo-cyst (OR 0.44, 95% CI 0.16 to 1.24; p=0.12); ICU admission (OR 1.64, 95% CI 0.97 to 2.77; p=0.06); and pneumonia development (OR 0.81, 95% CI 0.40 to 1.65; p=0.56) by urgent ERCP comparing with conventional approach for acute biliary pancreatitis without cholangitis. Henceforth, early ERCP in acute biliary pancreatitis without cholangitis did not reduce mortality, complications, and other adverse outcomes compared to the conservative treatment.

A high-volume ERCP service led by surgeons is associated with good outcomes and meets national key performance indicators: results from a British district general hospital.

Endoscopic retrograde cholangiopancreatography (ERCP) is a common, but technically challenging procedure used in the management of hepatopancreaticobiliary (HPB) disease. It is traditionally performed by medical gastroenterologists. In 2014, the British Society of Gastroenterology (BSG) proposed key performance indicators to evaluate and set standards of ERCP practice. This study aimed to compare our ERCP outcomes against these targets, in a centre where ERCP is exclusively performed by surgeons. A retrospective analysis of all ERCPs undertaken over a 38months in a District General Hospital in the United Kingdom (UK), by three Upper Gastrointestinal Surgeons. Study outcomes were based upon, and compared against, BSG key performance indicators, including number of ERCPs per annum, proportion of successful cannulations of bile duct and stone clearance, ERCP-specific complications and mortality. The unit's caseload over this period was 1324, equating to approximately 418 per annum (BSG minimum 200 per unit). Management of bile duct stones was the commonest indication for ERCP. Overall, 95% (1253/1324) of bile ducts were cannulated and 92% (645/698) for those undergoing their first ERCP. Bile duct clearance was achieved in 80% of patients (BSG recommend > 75%) and the successful stenting of extra-hepatic strictures in 94% (BSG recommend > 80%). The overall complication rate was 4.3% (BSG standard < 6%). Procedure-specific mortality was 0.3% (4/1324) where death was either caused by pancreatitis or sepsis. A high-volume ERCP service led and performed exclusively by surgeons meets all BSG performance indicators, with good procedural and patient outcomes. Formal training pathways should be developed to encourage more surgical centres to provide an ERCP service and deal with what are common surgical pathologies.

Outcome of ERCP related to case-volume

Background and aimsIn some studies, high endoscopic retrograde cholangiopancreatography (ERCP) case-volume has been shown to correlate to high success rate in terms of successful cannulation and fewer adverse events. The aim of this study was to analyze the association between ERCP success and complications, and endoscopist and centre case-volumes.MethodsData were obtained from the Swedish National Register for Gallstone Surgery and ERCP (GallRiks) on all ERCPs performed for Common Bile Duct Stone (CBDS) (n = 17,873) and suspected or confirmed malignancy (n = 6152) between 2009 and 2018. Successful cannulation rate, procedure time, intra- and postoperative complication rates and post-ERCP pancreatitis (PEP) rate, were compared with endoscopist and centre ERCP case-volumes during the year preceding the procedure as predictor.ResultsIn multivariable analyses of the CBDS group adjusting for age, gender and year, a high endoscopist case-volume was associated with higher successful cannulation rate, lower complication and PEP rates, and shorter procedure time (p < 0.05). Centres with a high annual case-volume were associated with high successful cannulation rate and shorter procedure time (p < 0.05), but not lower complication and PEP rates.When indication for ERCP was malignancy, a high endoscopist case-volume was associated with high successful cannulation rate and low PEP rates (p < 0.05), but not shorter procedure time or low complication rate. Centres with high case-volume were associated with high successful cannulation rate and low complication and PEP rates (p < 0.05), but not shorter procedure time.ConclusionsThe results suggest that higher endoscopist and centre case-volumes are associated with safer ERCP and successful outcome.

Outcomes of endoscopic retrograde cholangio-pancreatography in patients with liver transplant.

Biliary complications are the leading causes of morbidity and mortality after liver transplant (LT). However, national data on endoscopic retrograde cholangiopancreatography (ERCP) usage and outcomes in LT patients are lacking. Our study aims to identify the trends, outcomes, and predictors of ERCP and related complications in this patient subgroup. We derived our study cohort from the Nationwide Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project (HCUP) between 2007 and 2017. LT patients were identified using ICD-9/10CM diagnosis codes and patients who underwent ERCP were identified by ICD-9/10-CM procedure codes. We utilized the Cochrane-Armitage trend test and multivariate logistic regression to analyze temporal trends, outcomes, and predictors. A total of 372,814 hospitalizations occurred in LT patients between 2007 and 2017. ERCP was performed in 2.05% (n = 7632) of all hospitalizations. There was a rise in ERCP procedures from 1.96% (n = 477) in 2007 to 2.05% (n = 845) in 2017. Among LT patients who underwent ERCP, the in-hospital mortality rate was 1% (n = 73) and 8% (n = 607) were discharged to facilities. Mean length of hospital stay was 7 ±0.3 days. Septicemia was the most common periprocedural complication (18.3%, n = 1399) followed by post-ERCP pancreatitis (8.8%, n = 674). There has been an increase in ERCP procedures over the past decade among LT patients. Our study highlights the periprocedural complications and outcomes of ERCP in LT patients from a nationally representative dataset.

Endoscopic Retrograde Cholangiopancreatography in Acute Biliary Pancreatitis: Urgent vs. Delayed and the Outcome of Same-Admission Cholecystectomy.

Introduction: Acute pancreatitis (AP) represents a major burden for the medical system, associating important morbidity and mortality rates. This paper is focused on debatable aspects of the management of biliary AP, namely indications, timing and outcomes of endoscopic retrograde cholangiopancreatography (ERCP) on the hand and, on the other hand, same-admission cholecystectomy as a preventive measure for recurrent disease. Material and methods: This is a retrospective study including 108 patients with biliary AP in whom ERCP was performed, treated in the Clinical Emergency Hospital of Bucharest between 2016 and 2020. According to the urgency of the ERCP, we divided the patients into two groups: urgent versus delayed ERCP. Results: Urgent ERCP was performed in 52 patients, while delayed ERCP was performed in 56 patients; the hospital stay was higher in the urgent group than in the delayed group (10 days vs 8 days, p = 0.299) with no difference in morbidity rates. The mean time between ERCP and surgery was 5 days, without significant difference between the groups. The laparoscopic approach was the preferred method, with a conversion rate of 7%. Conclusion: ERCP with stone extraction followed by same-admission laparoscopic cholecystectomy is a safe therapeutic option, that prevents recurrent pancreatitis. The timing of the procedures remains debatable, further prospective studies being needed to achieve statistical significance.

The volume of ERCP per endoscopist is associated with a higher technical success and a lower post-ERCP pancreatitis rate. A prospective analysis.

conflicting results have been reported regarding the influence of the annual volume of endoscopic retrograde cholangiopancreatography (ERCP) on outcome. to evaluate the influence of case volume on ERCP outcomes. an analysis of a prospective database was performed, comparing the outcomes of ERCP in three consecutive periods defined by the number of endoscopists performing ERCP: five endoscopists in period I (P1), four in period II (P2) and three in period III (P3). Only patients with biliary ERCP in accessible and naïve papilla were included. Primary variables were cannulation rates and adverse effects (AE). The American Society of Gastrointestinal Endoscopy (ASGE) complexity grades III and IV were considered as highly complex procedures. a total of 2,561 patients were included: 727 (P1), 972 (P2) and 862 (P3). There were no differences in age and sex between groups (p > 0.05). The cannulation rate was significantly higher in P2 and P3: 92.4 % vs 93.3 % vs 93 % (p = 0.037). The AE rate was 13.8 %, 12.6 % and 10.3 % (p > 0.05), respectively. The rate of post-ERCP pancreatitis was significantly lower in P3: 8.5 %, 7.3 % and 5 % (p = 0.01). The rate of complex procedures was 12 %, 14.8 % and 27 % (p < 0.0001), respectively. Two endoscopists participated in all periods and only one had significantly improved outcomes. Cannulation and post-ERCP pancreatitis rates remained significantly better in P3 after adjusting for sex, complexity and endoscopist. a higher annual volume of ERCP per endoscopist was associated with a higher rate of cannulation and a lower rate of post-ERCP pancreatitis, despite the greater complexity of the procedures. These beneficial effects seem to differ between endoscopists.

O-L03 Safety and Efficacy of Endoscopic Retrograde Cholangiopancreatography for Removal of Common Bile Duct Stones in the Nonagenarians: A Single Tertiary Centre Experience

BackgroundIt is estimated that one in four persons in the UK will be > 65 years old by 2050. Endoscopic retrograde cholangiopancreatography (ERCP) is the recommended therapy for removals of common bile duct (CBD) stones. There is a lack of UK data on the outcome of ERCP in the very elderly. We aimed to investigate the safety and efficacy of ERCP in the management of CBD stones in the elderly >90 years old compared with those aged 65-89 years old.MethodsWe retrospectively analysed patients undergone ERCP between 2016-2020. Those with conditions other than suspected CBD stones were excluded. The following data was collected: general demographics, comorbidities, American Association of Anaesthesiology (ASA) grading, presence of dementia, anticoagulation therapy, endoscopic report on completed intention of treatment which is defined by either removal of stone and/or stent insertion. Also, post-procedure complications were collected including post-ERCP pancreatitis (PEP), bleeding, perforation, cholangitis, respiratory, and cardiovascular (CVS) events. Readmission within 7 days and death within 30 days were collected. Outcomes were reported as mean ± (SD) or n (%). Statistical significance was considered when P < 0.05.ResultsTotal, 126 patients ≥ 90 years(group A) compared to 262 patients aged 65-89 years(group B). Higher rate of dementia, and anticoagulation therapy in Group A (17.4%) vs (0.4%),p <0.0001 and (36.5%) vs (17.9%),p <0.0001,respectively. Completed treatment was achieved in group A(90.5%) compared to group B(89.9%),p 0.7. One patient (0.8%) had PEP group A compared to 8(3.1%) group B,p 0.3. Overall complications (13.5%) group A vs (9.5%) group B,p 0.3. Four cases (3.2%) died within 30-day in group A compared to group B 5 (1.9%), p 0.5. There was no procedure-related deathConclusionsERCP for removal of CBD stones in > 90 years old is effective. Risk of post-ERCP pancreatitis and overall adverse events were not higher in the > 90 years compared to 65-89 years old. We report a 30-day mortality rate of 3.2%. The most common cause of death was pneumonia including COVID-19 peumonia.

Outcome and early complications of Endoscopic Retrograde Cholangio-Pancreatography (ERCP): a cross-sectional study on 626 Patients

Background. ERCP is the gold standard procedure for diagnosis and potential treatment of biliary-pancreatic disorders with various distributions in different areas of the world. The study aimed to evaluate the findings, outcome, complications and technical experiences of ERCP, also by considering the correlation of findings with liver function tests (LFT) and imaging. Methods. In this descriptive – cross sectional data-based study for 12 years from 2007, 626 (43.9% male and 56.1%female; mean age 60 Ys) consecutive patients were subjected with therapeutic purpose at two referral hospitals. Results. Epigastric pain (40%), jaundice (39.4%) and pruritus (38.1%) were the most common indications. CBD was cannulated by optimal wire- guided sphincterotomy in 486(77.6%) patients. Precut was performed in 65(10.6%) with successful cannulation in 61 cases (93.8%) and 7.7% of complications, including perforation. A total success rate of 98% was obtained. The most common diagnoses were CBD stone(s) in 322 (51.4%) and biliary-pancreatic cancers in 114 (18.2%) of cases. No LFT (ALT, ALP and Bilirubin) predicted the diagnoses. The higher concordance rate of imaging studies in comparison with ERCP was 75% for stone(s) and the lower rate of 11.1% for tumors. Metallic stents were used in 15(2.4%) of inoperable malignant cases with life expectancy of more than 6 months. Complications occurred in 29 cases (4.6%) including duodenal perforation (0.8%), pancreatitis (1.6%) and bleeding (1.2%). Mortality rate was 0.4%. Conclusion. Although no single laboratory or imaging can exactly predict the finding or outcome, but by considering judicious case selection, appropriate use of available tools and standard techniques, the procedure could be safe with a few complications and higher success rates.

SP6.1.7 Meta-analysis of procedural outcomes of laparoscopic-assisted endoscopic retrograde cholangiopancreatography in patients with previous Roux-en-Y gastric bypass surgery

Abstract Aims To investigate the procedural outcomes of laparoscopic-assisted endoscopic retrograde cholangiopancreatography (ERCP) in patients with previous Roux-en-Y gastric bypass (RYGB) surgery. Methods We performed a systematic review in accordance with PRISMA statement standards to identify all studies reporting procedural outcomes of laparoscopic-assisted ERCP in patients with previous RYGB. The ROBINS-I tool was used to assess the risk of bias of the included studies. Fixed-effect and random-effects models were applied to calculate pooled outcome data. Results A total of 17 case series, enrolling 256 patients, were included. The mean age of included patients was 49. The mean procedure time was 137 minutes (95% CI 102-172). In terms of procedural success rates, the overall technical success was 95.3% (95% CI 92.5-97.5,I2=0%), papillary access success was 95.3% (95% CI 92.5-97.5,I2=0%), cannulation success was 95.3% (95% CI 92.5-97.5,I2=0%), sphincterotomy success was 96.1% (95% CI 93.5-98.1,I2=0%), and stone removal success was 95.9% (95% CI 92.4-98.4, I2=0%). Conversion to open was required in 4.7% (95% CI 2.5-7.6,I2=0%). In terms of complications, pancreatitis occurred in 4.7% (95% CI 2.3-8,I2=17%), cholangitis in 1.7% (95% CI 0.5 to 3.6,I2=0%), and perforation in 3.7% (95% CI 1.8- 6.3,I2=0%). The length of hospital stay was 3 days (95% CI 2-4). Conclusions Laparoscopic-assisted ERCP seems to be feasible, effective, and a safe method to access the biliary tract in patients with previous RYGB as indicated by high technical success rates and low complication rates. There is a need for comparative evidence regarding outcomes of laparoscopic ERCP in comparison with alternative treatment options.

Comparison of the impact of endoscopic retrograde cholangiopancreatography between pre-COVID-19 and current COVID-19 outbreaks in South Korea: Retrospective survey.

BACKGROUNDThe coronavirus disease 2019 (COVID-19) outbreak has markedly influenced the endoscopic patterns. Endoscopic retrograde cholangiopancreatography (ERCP) is an essential technique for pancreatobiliary disease but increases the risk of exposure to the virus-containing body fluid; however, the impact of COVID-19 on ERCP is unknown. AIMTo compare the number of endoscopic activities and to analyze the clinical outcomes of ERCPs before and during the COVID-19 outbreak in Daegu, South Kore.METHODSThis retrospective cohort study included patients aged ≥ 18 years who underwent ERCP between February 18 and March 28, 2020, at a tertiary hospital. ERCP indications and endoscopic details were compared with those from the same period in 2018 and 2019 as control groups.RESULTSOf the 269 ERCP procedures, 113 (42.0%) cases were performed as emergency procedures. The number of ERCP procedures in 2018 and 2019 decreased by 20.2% and 56.6%, respectively, compared with that in 2020 (P < 0.01); among the 113 emergency ERCPs, the observed numbers in 2018 (n = 42) and 2019 (n = 55) dramatically dropped by 61.9% and 70.9%, respectively, compared with that in 2020 (n = 16). Of the 16 cases in 2020, stone removal was performed in five, biliary stenting in five, sphincterotomy in five, and nasobiliary drainage in one. No case of ERCP-related infection in medical workers or other patients has been reported.CONCLUSIONThe COVID-19 outbreak significantly reduced the number of ERCPs; however, there is no difference in the indications and endoscopic interventions before and during the COVID-19 outbreak.

S972 Malnutrition Is Associated With Worse Outcomes of Endoscopic Retrograde Cholangiopancreatography: A Nationwide Analysis

Introduction: Malnutrition is commonly found among hospitalized patients, and it is generally known to be associated with poor clinical outcomes. However, there is a lack of studies on how malnutrition affects the outcomes of endoscopic retrograde cholangiopancreatography (ERCP). Thus, this study aims to assess the outcomes of ERCP among patients with malnutrition. Methods: Adult patients hospitalized with a procedure diagnosis of ERCP from the National Inpatient Sample, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality 2014 were selected. Diagnoses were identified by using ICD-9 CM codes. Patient demographics and outcomes of ERCP were compared between the groups with and without malnutrition. The outcomes of interest were inpatient mortality, length of stay, total hospital charge, and ERCP complications including pancreatitis, cholecystitis, cholangitis, sepsis, hemorrhage, and intestinal perforation. Chi-squared tests and independent t-tests were used to compare proportions and means, respectively. Multivariate logistic regression analysis was performed to determine if malnutrition is an independent predictor for the outcomes, adjusting for age, sex, race, and the Charlson Comorbidity Index. Results: Among 5,664 patients with a procedure diagnosis of ERCP identified, 746 patients had a history of malnutrition. Patients with malnutrition had longer length of stay (15.5 days vs. 6.7 days, p < 0.05) and higher hospital charge ($149,699 vs. $71,723, p < 0.05). After adjusting for age, sex, race, and the Charlson Comorbidity Index, malnutrition was an independent risk factor for inpatient mortality (aOR 2.54, 95% CI: 1.70-3.82, p < 0.05), sepsis (aOR 2.20, 95% CI: 1.82-2.65, p < 0.05), hemorrhage (aOR 1.64, 95% CI: 1.05-2.56, p < 0.05), and intestinal perforation (aOR 4.29, 95% CI: 1.61-11.46, p < 0.05). Adjusted odds ratios of other outcomes were not statistically significant. Conclusion: Our study indicates that patients with malnutrition are more likely to have worse outcomes, such as increased inpatient mortality and higher risks of sepsis, hemorrhage, and intestinal perforation. Understanding the nutrition status of patients undergoing ERCP can be a useful approach for risk stratification and determining if closer surveillance of the complications is warranted.

S1058 Association of Hospital Procedural Volume with Outcomes of Endoscopic Retrograde Cholangio-Pancreatography

Introduction: Endoscopic Retrograde Cholangio-Pancreatography (ERCP) is well established procedure for treatment and diagnosis of various pancreato-biliary diseases. Post-ERCP pancreatitis (PEP) is the most common complication of ERCP. Data on relationship of hospital volume with outcomes of ERCP is lacking. We aimed to study outcomes of ERCP based on hospital volume. Methods: We utilized National Inpatient Sample database 2016 to identify all adult ( >=18 years) patients with primary procedure diagnosis of ERCP. We then classified patients based on hospital volume Hospitals were categorized into 3 groups based on tertiles of annual procedural volume: low (5-50 cases/year), medium (50 to 110 cases/year), and high (110 - 505 cases/year). The primary outcome was PEP, in-hospital mortality, post-ERCP bleeding and bile duct perforation. Multivariate logistic regression analyses were performed to examine the association of hospital ERCP volume and outcomes. Results: Our study included 94,055 ERCPs procedures performed across 2102 hospitals with median annual procedural volume of 70 (interquartile range: 40 to 140). Compared to low volume hospitals, medium and high-volume hospitals had younger patients, less females, more elective procedures, and more patients with pancreatic cancer and less with CBD stone (Table 1). L Therapeutic interventions including bile duct dilation, bile duct stenting, pancreatic duct dilation and pancreatic duct stenting was significantly higher performed in high and medium volume hospital compared to low volume hospitals (Table 1). The length of stay and total cost was also more in high volume hospitals. On multivariate analysis, odds ratio of PEP comparing high vs. Low, medium vs. Low and high vs medium was 1.41 (95% confidence interval 1.33 - 1.49, p< 0.001), 1.21 (95% CI 1.14-1.29, p< 0.001) and 1.16 (1.10-1.23, p< 0.001), respectively (Table 2). Similarly, high volume hospitals also had significantly higher odds of post-ERCP bleeding compared to low (OR 2.05, p< 0.001) and medium volume hospitals (OR 1.71, p< 0.001). In-hospital mortality was also higher in high and medium-volume hospitals as compared to low volume hospitals (Figure 1). Conclusion: Higher hospital ERCP volume is associated with higher rates of PEP, bleeding, and worse outcomes. This is likely resulting from high comorbidity burden and higher number of patients with pancreatic cancer requiring advanced therapeutics in high volume centers. Further studies are needed to determine to validate our findings.Table 1Figure 1.: Forrest plot and influence analysis - Functional Success of SIS and SBS in relieving malignant hilar biliary obstruction.

S3373 Outcomes of Endoscopic Retrograde Cholangiopancreatography (ERCP) in Patients With Chronic Pancreatitis – A National Inpatient Sample Study (2012-2018)

S3373 Outcomes of Endoscopic Retrograde Cholangiopancreatography (ERCP) in Patients With Chronic Pancreatitis – A National Inpatient Sample Study (2012-2018)

S3370 Impact of Acute Kidney Injury on In-Hospital Outcomes of Endoscopic Retrograde Cholangiopancreatography

S3370 Impact of Acute Kidney Injury on In-Hospital Outcomes of Endoscopic Retrograde Cholangiopancreatography