Joshua Tierney, MD, Neal Bhutiani, MD, Bryce Stamp, BS, John Richey, MD, Michael H Bahr, MD, Gary C Vitale, MD. University of Louisville Department of Surgery
Background: Despite the low overall incidence of cholangitis following an ERCP, it can be a source of increased hospital cost and morbidity with the need for additional procedures and hospital admissions in these patients. Little is known with regard to the pre-procedural risk factors for developing post-ERCP cholangitis. The objective of this study was to identify such risk factors amongst patients undergoing ERCP for pancreaticobiliary obstruction.
Methods: 3,648 ERCPs performed at the University of Louisville from 2008-2016 were reviewed for patients undergoing ERCP for pancreaticobiliary obstruction. Combined procedures performed at the time of ERCP such as endoscopic pancreatic pseudocyst drainage were excluded. Data including patient demographics, diagnostic, laboratory, and ERCP related data were all recorded. Patients were classified as having post-ERCP cholangitis if they developed jaundice, fever, right upper quadrant abdominal pain and confirmatory findings of stent occlusion and/or purulent drainage at the time of repeat ERCP. These patients were compared to those who did not develop post-ERCP cholangitis using Mann-Whitney U test for continuous variables and Fisher exact test for categorical variables. Multivariate logistic regression was also performed for all continuous and select categorical variables. Differences were considered significant for p<0.05.
Results: A total of 431 patients met inclusion criteria. Of these, 57 developed post-ERCP cholangitis. On univariate analysis, compared to patients undergoing ERCP who did not develop cholangitis (controls), patients developing post-ERCP cholangitis were more likely to be of increase age, have higher while blood cell count (WBC), total bilirubin (TBili), AST, ALT, and alkaline phosphatase (Alk Phos), and a decreased serum albumin level (Table 1). They were also more likely to have a diagnosis of bile duct structure or cancer, have a biliary stent placed at time of ERCP, and have multiple stents during index ERCP (Table 1). On multivariate analysis, elevated WBC, AST, ALT, and Alk Phos, multiple biliary stents, and a diagnosis of cancer were all associated with development of post-ERCP cholangitis (Table 1). On multivariate analysis after dichotomization based on median values of clinical and demographic variables of control patients, only elevated Alk Phos (p=0.04), placement of multiple biliary stents (p<0.0001), and a diagnosis of cancer (p<0.0001) were associated with development of post-ERCP cholangitis.
Conclusions: Development of post-ERCP cholangitis is strongly associated with an elevation in alkaline phosphatase (reflective of an underlying obstructive process), the presence of malignancy, and the placement of multiple biliary stents.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80170
Program Number: S004
Presentation Session: Biliary
Presentation Type: Podium