# Advanced chronic kidney disease increases the odds of ERCP adverse events but not post-ERCP pancreatitis: a propensity-matched analysis of the US Collaborative Network

## TL;DR

Advanced chronic kidney disease increases the risk of certain ERCP complications but not post-ERCP pancreatitis, challenging previous assumptions.

## Contribution

This study identifies that advanced CKD patients face higher odds of ERCP-related adverse events except for post-ERCP pancreatitis.

## Key findings

- Advanced CKD patients had higher odds of bleeding, cholangitis, ICU admissions, intubation, and mortality after ERCP.
- Post-ERCP pancreatitis and perforation odds were similar between advanced CKD and control groups.
- ESRD patients specifically had increased odds of ICU admissions.

## Abstract

Patients with chronic kidney disease (CKD) are at an increased risk choledocholithiasis, requiring intervention with endoscopic retrograde cholangiopancreatography (ERCP). Data on ERCP-related adverse events in this population is limited, hence this study.

This retrospective cohort study utilized the TriNetX database to assess the odds of ERCP-related adverse events in patients with stages 4 and 5 chronic kidney disease, as well as end-stage renal disease (ESRD) on dialysis. Primary outcomes were ERCP-related pancreatitis (PEP), bleeding, cholangitis, and perforation. Secondary outcomes were failure to extubate/new post-procedure intubation, intensive care unit (ICU) admissions, and all-cause mortality.

After propensity score matching, our study included 4450 patients in the aCKD cohort and 4450 patients in the matched control cohort who underwent ERCP. Patients with aCKD had an increased odds of bleeding (OR 2.1, p < 0.001), cholangitis (OR 1.6, p < 0.001), ICU admissions (OR 2.2, p < 0.001), intubation (OR 3.0, p < 0.001) and mortality (OR 1.8, p < 0.001) compared to those with normal renal function. The odds of PEP (OR 1.1, p = 0.542) and perforation (OR 1.3, p = 0.528) were statistically similar between the two cohorts. No subgroup differences in ERCP-related AE were found except for increased ICU admissions odds in ESRD patients.

aCKD patients are a demonstrably high-risk group for certain ERCP-related AEs but not for PEP or perforation, a finding that may change the previous widespread perception of increased PEP risk in this population. Additional studies are needed to validate our findings and investigate potential interventions to improve clinical outcomes in this high-risk population.

The online version contains supplementary material available at 10.1007/s00464-025-12323-x.