Published online Nov 7, 2018. doi: 10.3748/wjg.v24.i41.4691
Peer-review started: August 8, 2018
First decision: August 24, 2018
Revised: October 4, 2018
Accepted: October 16, 2018
Article in press: October 16, 2018
Published online: November 7, 2018
To determine if end-stage renal disease (ESRD) is a risk factor for post endoscopic retrograde cholangiopancreatography (ERCP) adverse events (AEs).
We performed a retrospective cohort study using the Nationwide Inpatient Sample (NIS) 2011-2013. We identified adult patients who underwent ERCP using the International Classification of Diseases 9th Revision (ICD-9-CM). Included patients were divided into three groups: ESRD, chronic kidney disease (CKD), and control. The primary outcome was post-ERCP AEs including pancreatitis, bleeding, and perforation determined based on specific ICD-9-CM codes. Secondary outcomes were length of hospital stay, in-hospital mortality, and admission cost. AEs and mortality were compared using multivariate logistic regression analysis.
There were 492175 discharges that underwent ERCP during the 3 years. The ESRD and CKD groups contained 7347 and 39403 hospitalizations respectively, whereas the control group had 445424 hospitalizations. Post-ERCP pancreatitis (PEP) was significantly higher in the ESRD group (8.3%) compared to the control group (4.6%) with adjusted odd ratio (aOR) = 1.7 (95%CI: 1.4-2.1, aP < 0.001). ESRD was associated with significantly higher ERCP-related bleeding (5.1%) compared to the control group 1.5% (aOR = 1.86, 95%CI: 1.4-2.4, aP < 0.001). ESRD had increased hospital mortality 7.1% vs 1.15% in the control OR = 6.6 (95%CI: 5.3-8.2, aP < 0.001), longer hospital stay with adjusted mean difference (aMD) = 5.9 d (95%CI: 5.0-6.7 d, aP < 0.001) and higher hospitalization charges aMD = $+82064 (95%CI: $68221-$95906, aP < 0.001).
ESRD is a risk factor for post-ERCP AEs and is associated with higher hospital mortality. Careful selection and close monitoring is warranted to improve outcomes.
Core tip: Recognizing risk factors for endoscopic retrograde cholangiopancreatography (ERCP)-related complications is essential to reduce adverse events (AEs). There are limited data evaluating ERCP outcomes in renal disease. In a retrospective cohort study using the Nationwide Inpatient Sample 2011-2013 and including 492175 discharges, we compared inpatient ERCP AEs, mortality and length of stay between patients with and without renal disease. We found end-stage renal disease (ESRD) to be associated with higher post ERCP pancreatitis [8.3%, adjusted odd ratio (aOR) = 1.7, aP < 0.001], bleeding (5.1%, aOR = 1.86, aP < 0.001), mortality (7.1%, aOR = 6.6, aP < 0.001) and longer hospital stay (5.9 d, aP < 0.001). Physicians should consider special interventions in ESRD patients to decrease ERCP AEs.