Retrospective Cohort Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 7, 2018; 24(41): 4691-4697
Published online Nov 7, 2018. doi: 10.3748/wjg.v24.i41.4691
End-stage renal disease is associated with increased post endoscopic retrograde cholangiopancreatography adverse events in hospitalized patients
Tarek Sawas, Fateh Bazerbachi, Samir Haffar, Won K Cho, Michael J Levy, John A Martin, Bret T Petersen, Mark D Topazian, Vinay Chandrasekhara, Barham K Abu Dayyeh
Tarek Sawas, Fateh Bazerbachi, Michael J Levy, John A Martin, Bret T Petersen, Mark D Topazian, Vinay Chandrasekhara, Barham K Abu Dayyeh, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States
Samir Haffar, Department of Gastroenterology, Digestive Center for Diagnosis and Treatment, Damascus 00000, Syrian Arab Republic
Won K Cho, Division of Gastroenterology and Hepatology, Georgetown University Medstar Washington Hospital Center, Washington, DC 20010, United States
Author contributions: Sawas T contributed to the study design, data analysis and interpretation and drafting the manuscript; Bazerbachi F, Haffar S, Cho WK, Levy MJ, Martin JA, Petersen BT, Topazian MD, Chandrasekhara V and Abu Dayyeh BK contributed to data interpretation and drafting the manuscript.
Institutional review board statement: This study is IRB exempted under category 4 “Research involving the study of publically available data (Nationwide Inpatient Sample)”.
Informed consent statement: The study was performed on publically available data without patient’s identifier. No consent was required for this study.
Conflict-of-interest statement: Authors have nothing relevant to this study to disclose.
Data sharing statement: Statistical code, and dataset available from the corresponding author at Informed consent for data sharing was not obtained but the presented data are anonymized and risk of identification is low.
STROBE statement: The guidelines of the STROBE statement have been adopted.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Barham K Abu Dayyeh, MD, MPH, Attending Doctor, Associate Professor, Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Ave., S.W., Rochester, MN 55905, United States.
Telephone: +1-507-2841825 Fax: +1-507-5385820
Received: August 8, 2018
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.

Keywords: End-stage renal disease, Nationwide Inpatient Sample, Endoscopic retrograde cholangiopancreatography

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.