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
Research background

End-stage renal disease (ESRD) is associated with increased risk for biliary diseases. Endoscopic retrograde cholangiopancreatography (ERCP) is the standard treatment for most biliary diseases. Prior data have shown renal disease to be a risk factor for perforation during other endoscopic procedures such as colonoscopy and a proven mortality predictor in upper gastrointestinal bleeding. There are limited published data evaluating ERCP outcomes in ESRD.

Research motivation

The American Society for Gastrointestinal Endoscopy (ASGE) guideline emphasized the importance of recognizing risk factors for ERCP-related complications, careful patient selection, and targeted maneuvers to reduce the risk of adverse events (AEs). We hypothesized that ESRD is associated with higher ERCP AEs. This would guide endoscopists in efforts to undertake focused interventions to reduce the incidence of these AEs.

Research objectives

The main objective of our study is to evaluate ERCP outcomes in ESRD using a large national cohort. We evaluated the association between ESRD and AEs, hospital mortality, length of stay and cost.

Research methods

In a retrospective cohort study using the Nationwide Inpatient Sample (NIS) years 2011-2013 and including 492175 discharges, we compared inpatient ERCP AEs between patients with ESRD and individuals without renal diseases. We compared ERCP outcomes using logistic regression model and applying appropriate weighted sampling design.

Research results

ESRD was associated with higher AEs including post ERCP pancreatitis [8.3%, adjusted odd ratio (aOR) = 1.7, aP < 0.001] and bleeding (5.1%, aOR = 1.86, aP < 0.001) compared to patients without renal disease. ESRD was also associated with higher hospital mortality (7.1%, OR = 6.6, aP < 0.001) and longer hospital stay [mean difference (MD) = 5.9 d, aP < 0.001]. The remaining problem is identifying appropriate interventions to minimize AEs in this high-risk group

Research conclusions

ESRD is associated with higher post ERCP AEs and hospital mortality and longer hospital stay. The current study emphasizes on the importance of identifying risk factors for ERCP AEs and include ESRD as a one these factors. Based on these findings, physicians might consider special peri-procedure interventions in ESRD patients in efforts to decrease AEs including careful patient selection, optimization of fluid volume status and use of various prophylactic or therapeutic endoscopic interventions, with closer observation after ERCP.

Research perspectives

ESRD is associated with higher ERCP AEs, higher mortality and longer hospital stay. Additional prospective studies are needed to investigate the value of any particular intervention in improving clinical outcomes following ERCP in this high-risk population.