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
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.
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.
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.
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.
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
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.
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.