Endoscopy 2020; 52(S 01): S212
DOI: 10.1055/s-0040-1704662
ESGE Days 2020 ePoster Podium presentations
Saturday, April 25, 2020 11:00 – 11:30 ERCP: Chronic pancreatitis ePoster Podium 2
© Georg Thieme Verlag KG Stuttgart · New York

BILIARY INTERVENTIONS IN PATIENTS WITH STERILE PANCREATIC AND PERIPANCREATIC NECROSIS INCREASE THE RISK FOR INFECTED COLLECTION

CR Simons-Linares
1   Cleveland Clinic, Gastroenterology and Hepatology, Cleveland, USA
,
K Vantanasiri
2   University of Minnesota, Gastroenterology and Hepatology, Minneapolis, USA
,
V Chittajallu
1   Cleveland Clinic, Gastroenterology and Hepatology, Cleveland, USA
,
A Sims
1   Cleveland Clinic, Gastroenterology and Hepatology, Cleveland, USA
,
C Cuvillier
1   Cleveland Clinic, Gastroenterology and Hepatology, Cleveland, USA
,
A Dirweesh
1   Cleveland Clinic, Gastroenterology and Hepatology, Cleveland, USA
,
MA Saleh
1   Cleveland Clinic, Gastroenterology and Hepatology, Cleveland, USA
,
T Stevens
1   Cleveland Clinic, Gastroenterology and Hepatology, Cleveland, USA
,
C Martin
1   Cleveland Clinic, Gastroenterology and Hepatology, Cleveland, USA
,
ML Freeman
2   University of Minnesota, Gastroenterology and Hepatology, Minneapolis, USA
,
G Trikudanathan
2   University of Minnesota, Gastroenterology and Hepatology, Minneapolis, USA
,
P Chahal
1   Cleveland Clinic, Gastroenterology and Hepatology, Cleveland, USA
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

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Aims It is unclear if antecedent biliary interventions (BI) [ERCP, PHTC] performed for biliary obstruction pose risk of infecting evolving sterile pancreatic and or peripancreatic necrosis (PPN). We sought to determine if BIs increase the risk of infection in PPN patients.

Methods All patients with necrotizing pancreatitis in two academic centers (2009-2019) were identified from a prospectively maintained registry. Same admission cholecystectomy patients were excluded. Patients with a sterile necrosis who underwent BIs for biliary obstruction without cholangitis were compared with controls who did not undergo any BIs. Primary outcome of interest was rate of infected PPN post intervention. Analysis was adjusted for age, gender, BMI, AP severity, AP etiology, PPN type and size.

Results Among 959 PPN patients, 72 met inclusion criteria for BIs and were compared with 305 controls. On univariate analysis, BI patients were more likely to have index gallstone-AP (34.7% vs. 12.2%; p< 0.001) and Post-ERCP AP (19.4% vs 2%; p< 0.001). After adjusting for confounders, in multivariate analysis, the latter differences were not significant (table 1), but BIs patients were still 3 times more likely to have idiopathic AP as etiology (aOR 3.2; p=0.037). No differences in PPN type or size were found. BIs patients had 2.4 times higher risk for PPN infection (aOR 2.3; p=0.010), 5 times more likely to require PPN intervention/drainage, 4 times more likely to require a PPN re-intervention after initial drainage. In BIs patients, LOS was almost 2 extra days (20.1 vs 18.8 days; P=0.73). No differences in mortality, ICU requirement and antibiotic duration in both groups (12.4 vs. 11.7 days; P=0.66) were found between the two groups.

Conclusions BIs in sterile PPN increase the risk of infecting necrotic collections, leading to higher rates of collection intervention and reintervention. Biliary interventions should be avoided for asymptomatic biliary obstruction in patients with evolving PPN.