AT DDW 2015

Washington – When it’s given early in the course of treatment for patients who have acute pancreatitis and biliary obstruction without cholangitis, endoscopic retrograde cholangiopancreatography (ECRP) is associated with shorter lengths of stay, reductions in infectious complications, and substantially lower costs.

In more than 10,000 hospitalizations related to acute pancreatitis with choledocholithiasis/biliary obstruction with cholangitis, ECRP performed on the day of admission or the next day was associated with a significantly lower risk for septicemia than ECRP performed after the first full day of hospitalization, and hospitalization costs were nearly $20,000 lower when the procedure was done early in the course of care, reported Dr. Raxitkimar Jinjuvadia from the Henry Ford Hospital in Detroit.

“Even though the inpatient mortality did not differ among the early and late groups, early ERCP has significant other benefits in reducing health care resources utilization,” he said at the annual Digestive Disease Week.

The study’s use of a large, nationally representative hospital sample supports and adds weight to current guidelines on the use of ERCP from the American Society for Gastrointestinal Endoscopy (ASGE).

“We suggest that early ERCP should be encouraged for patients with acute biliary pancreatitis with biliary obstruction and without cholangitis,” he stated.

The investigators took a retrospective stroll through data from the National Inpatient Sample (NIS) database for the year 2011. From among approximately 8 million hospitalizations in about 1000 hospitals in the United States, they identified patients who presented with acute pancreatitis, choledocholithiasis, biliary obstruction, and cholangitis, as determined by International Classification of Disease, 9th Revision (ICD-9) codes.

The cohort included 10,364 hospitalizations related to acute pancreatitis with choledocholithiasis/biliary obstruction without cholangitis. The mean age of patients was 57.2 years, 66.4% were white and 62.2% were female. In all, 58.9% of patients underwent ERCP at some point during their hospitalizations, with 48.6% receiving it early (day 0 or day 1).

Patients who had ERCP had a significantly lower rate of inpatient deaths compared with those who did not have the procedure (0.5% vs, 1.7%, P < .001), but the timing of the procedure, the primary endpoint, did not make a difference in in-hospital mortality.

However, when the authors looked at secondary outcomes, they found that early ERCP was associated with significantly lower rates of septicemia (4.0% vs 7.2%, P < .001), shorter mean length of stay (5.2 vs. 8.0 days, P < .001) and lower costs ($52,400 vs $71,736, P <. 001).

In multivariable modeling adjusted for age, sex, race and Elixhauser comorbidities, independent risk factors for in-hospital mortality were age (adjusted odds ratio [aOR], 1.04, 95% confidence interval [CI] 1.03-1.06), Elixhauser comorbidities (aOR 1.17, 95% CI, 1.06-1.29), ERCP during hospitalization (aOR 0.30, 95% CI 0.19-0.47), and septicemia (aOR 13.5, 95% CI, 8.75-20.75).

As noted before, early ERCP was not an independent risk factor for inpatient mortality.

Dr. Jinjuvadia said that the study was limited by potential biases related to ICD-9 coding; the lack of lab values, imaging, or treatment data; and the fact that the database does not include data from Veterans Affairs hospitals.