A237 INCIDENCE, RISK FACTORS, AND OUTCOMES OF POST-ERCP CHOLANGITIS: AN INTERNATIONAL MULTICENTER PROSPECTIVE STUDY

TL;DR

This study finds that post-ERCP cholangitis occurs in 1.7% of cases and is linked to factors like male sex and longer procedures, with high mortality rates.

Contribution

The study provides new international prospective data on post-ERCP cholangitis incidence, risk factors, and outcomes.

Findings

Post-ERCP cholangitis occurred in 1.7% of 8,119 ERCP procedures.

Male sex, longer procedural time, and biliary strictures were identified as risk factors.

Mortality attributed to cholangitis was 8.2% of incident cases.

Abstract

Cholangitis is a well-described adverse event (AE) following endoscopic retrograde cholangiopancreatography (ERCP) that is associated with significant morbidity and mortality. Despite this, contemporary characterization of this AE using high-quality prospective data is incomplete.

In this study we describe post-ERCP cholangitis incidence, risk factors, and outcomes in a large, international multicenter population of patients undergoing ERCP.

We analyzed prospective data from nine centers in Canada, USA, and Europe between 2018-2024 with 30-day follow-up. The primary outcome was post-ERCP cholangitis, defined as (1) temperature <36.0°C or >38.0°C or white blood cells <4 x109/L or >10x109/L, (2) accompanying rise in bilirubin or transaminases to >1.5 times the upper limit of normal or any increase compared to pre-procedure, and (3) emergency department visit or hospital admission and/or prolongation of existing admission. Multivariable logistic regression was performed to identify risk factors, with results presented as odds ratios (OR) with associated 95% confidence intervals. Outcomes following cholangitis were also described.

Post-ERCP cholangitis occurred following 134 (1.7%) of 8,119 ERCPs (mean onset of symptoms 2.0 days). Repeat ERCP was required in 53.7% of these cases. Mortality attributed to cholangitis occurred in 8.2% of incident cases. Male sex (OR 1.48, 1.02-2.19), longer procedural time (OR 1.01, 1.00-1.02 per additional minute) and presence of a biliary stricture (OR 3.24, 1.98-5.30) were all independent risk factors for post-ERCP cholangitis, while placement of a biliary stent (OR 0.59, 0.36-0.95), and biliary sphincterotomy (OR 0.59 0.39-0.87) were both protective against post-ERCP cholangitis.

Post-ERCP cholangitis is common and associated with high mortality rates. Adequate pre-procedural counseling and early recognition is advised, especially in patients at increased risk.

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