Outcomes and timing of endoscopic retrograde cholangiopancreatography for acute biliary pancreatitis.

Abstract

BACKGROUND\nIndication of endoscopic retrograde cholangiopancreatography (ERCP) in acute biliary pancreatitis (ABP) is challenging.\n\n\nAIMS\nIn this retrospective study, we analyzed real-world data to understand the ERCP practice in ABP in Hungarian centers.\n\n\nMETHODS\nClinical data on ABP patients (2013-2015) were extracted from our large multicentric database. Outcomes, quality indicators and the role of early timing of ERCP (<24\u2009h from admission) were analyzed.\n\n\nRESULTS\nThere were 356 patients with ABP. ERCP was performed in 267 (75%). Performance indicators of ERCP proved to be suboptimal with a biliary cannulation rate of 84%. Successful vs unsuccessful cannulation of naïve papilla resulted in lower rates of local [22.9% vs 40.9%, (P\u2009=\u20090.012)] and systemic [4.9% vs 13.6%, (P\u2009=\u20090.042)] complications. Successful vs unsuccessful clearance resulted in lower rates of local complications [22.5% vs 40.8%, (P\u2009=\u20090.008)]. Successful cannulation and drainage correlated with less severe course of ABP [3.6% vs 15.9%, (P\u2009=\u20090.001) and 4.1% vs 12.2%, (P\u2009=\u20090.033)] respectively. A tendency of an increased rate of local complications was observed if ERCP was performed later [<24\u2009h: 21.1% (35/166); between 24-48\u2009h: 23.4% (11/47); >48h: 37.2% (16/43) (P\u2009=\u20090.088)].\n\n\nCONCLUSION\nOptimization of ERCP indication in ABP patients is critical as suboptimal ERCP practices in ABP without definitive stone detection are associated with poorer clinical outcomes.