TOPLINE

Patients with chronic kidney disease, congestive heart failure, or liver cirrhosis who underwent endoscopic retrograde cholangiopancreatography (ERCP) had increased odds of in-hospital death and morbidity compared with those without these conditions.

METHODOLOGY

• ERCP is more complex and carries greater risks than diagnostic endoscopy, especially for patients with chronic illnesses. Prior studies have linked liver cirrhosis to worse ERCP outcomes, but the effects of ERCP in patients with other high-risk comorbidities remain unclear.
• Researchers analyzed data from a US-based sample of adults who underwent ERCP between 2016 and 2022 to assess the associations between high-risk comorbidities and inpatient outcomes and to develop predictive models for adverse events.
• High-risk comorbidity was defined as the presence of at least one of these comorbidities: chronic kidney disease, congestive heart failure, or liver cirrhosis.
• Primary outcomes were inpatient mortality and a composite morbidity endpoint comprising cardiovascular, respiratory, hematologic, infectious, or renal complications. Secondary outcomes included length of hospital stay, total hospital charges, and total costs.
• Researchers built statistical models to predict in-hospital outcomes. They used 80% of the dataset to train the model and the remaining 20% for model validation.

TAKEAWAY

• The analysis included 1,171,973 ERCP procedures. Among the patients who underwent these procedures, 267,739 (22.8%) had at least one high-risk comorbidity (mean age, 71.8 years; 45.1% women).
• Patients with high-risk comorbidities had 3.80-fold higher odds of inpatient mortality and 3.22-fold higher odds of inpatient morbidity (P < .05 for both). Liver cirrhosis was linked to the highest odds of mortality (4.53-fold), and congestive heart failure was linked to the highest odds of morbidity (2.84-fold; P < .05 for both).
• Patients with high-risk comorbidities had longer hospital stays (mean, 8.5 vs 5.3 days) and incurred higher mean total hospital charges ($122,635 vs $81,984) than those without such comorbidities (P < .001 for both).
• The predictive models achieved area under the receiver operating characteristic curve values of 0.76 for mortality and 0.73 for morbidity.

IN PRACTICE

“High-risk patients may benefit from multidisciplinary care pathways, including preprocedure optimization of fluid status, nutritional support, or closer monitoring in the periprocedural period. These strategies are especially relevant as the population of medically complex patients requiring ERCP continues to grow,” the authors of the study wrote.

SOURCE

The study was led by Zachary D. Leslie, Carleton College, Northfield, Minnesota. It was published online in Digestive Diseases and Sciences.

LIMITATIONS 

The study was retrospective and relied on administrative coding for diagnoses. Researchers could not capture long-term or postdischarge complications. Detailed data on procedures and operator experience were not available.

DISCLOSURES

The study did not receive any funding. Two authors reported serving as consultants for several medical device and industry companies. One of those authors also reported receiving research support from industry. 

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.