Early endoscopic retrograde cholangiopancreatography (ERCP) does not significantly affect inpatient mortality, but is associated with a shorter hospital length of stay and lower hospitalization costs among patients with acute biliary pancreatitis, according to study results presented at Digestive Disease Week (DDW), held from May 21 to 24, 2022, in San Diego, California, and virtually.
Investigators sought to assess the benefit of early vs late ERCP in patients admitted with acute biliary pancreatitis without acute cholangitis. They used data from the National Inpatient Sample from 2016 to 2018 and International Classification of Diseases-10 codes to identify diagnoses and procedures. Early ERCP was defined as being performed within 24 hours of hospitalization.
The primary outcome was in-hospital mortality. Secondary outcomes included hospital length of stay and hospitalization cost, which was adjusted for inflation. Multiple logistic regression was used to adjust for age, sex, race, and comorbidities, and to calculate adjusted odd ratios (OR).
A total of 52,598 patients (median age, 59 years; 59.9% women) were admitted between 2016 and 2018, of whom 9608 (18.3%) had ERCP. The median time to ERCP was day 2, and the mean was day 2.4 (95% CI, 2.35-2.47). Of the ERCP procedures, 966 (10.1%) were conducted within 24 hours of admission.
Patients who underwent ERCP had a lower inpatient mortality compared with non-ERCP patients (0.5% vs 1.5%, P <.001). The mortality rate was identical in the early vs late ERCP groups (0.52% vs 0.54%, P =.931). The adjusted OR for mortality with early ERCP was 1.07 (95% CI, 0.42-2.75; P =.885).
The early ERCP group had a shorter length of stay compared with the late group (3.7 days vs 5.5 days, P <.001). The early ERCP group also had total lower hospital costs compared with the late ERCP group ($61,936 vs $73,603, P <.001).
The study authors concluded, “If validated in prospective fashion and in larger patient populations, these data may have significant implications on clinical practice and our understanding of the role of ERCP in acute biliary pancreatitis.”
Tahir MW, Tariq R, Tahir Z, Mallick AH, Kaul V. Early vs. late ERCP for management of acute biliary pancreatitis without acute cholangitis: a nationwide analysis from 2016-2018. Presented at: DDW 2022; May 21-24, 2022; San Diego, CA. Presentation Sa1321.