Post-ERCP pancreatitis may result in poorer survival for patients with periampullary cancer awaiting pancreaticoduodenectomy- A Swedish registry study

Aims Post-ERCP pancreatitis (PEP) is one of the most severe complications of ERCP, especially for patients with periampullary cancer (PAC) awaiting surgery. Although clinical observations suggest that pancreatitis may reduce the likelihood of curative surgery and affect long-term survival, the specific effect of PEP on survival has never been studied. This study aimed to explore PEP and its possible effect on overall survival in a national cohort of Swedish patients who underwent pancreaticoduodenectomy (PD) for periampullary cancer (PAC). A secondary endpoint was to evaluate if tumour resectability is affected by PEP.

Methods Two large Swedish national registries were matched to extract data. First, data from the Swedish National Registry for patients with tumours in the pancreatic and periampullary region between 2010–2018 was collected. Those with pre-operative biliary drainage using ERCP were identified and matched with the Swedish biliary registry (Gallriks) to collect data on post-ERCP complications and survival. Kaplan-Meier curves, log-rank tests and chi square tests were performed to analyse survival and resectability.

Results Out of the 4209 pancreaticoduodenectomy patients in the registry, 2776 patients had undergone pre-operative ERCP of whom 1709 met the inclusion criteria and could be matched with the biliary registry. Of these, 77 patients had PEP (4,5%) and the remaining 1632 patients had no pancreatitis (95.5%). Log Rank test using Kaplan Meier survival curve showed a significant poorer overall survival (p=0.05) in the group with patients suffering from PEP prior to their intended curative surgery. Furthermore, for six of these patients, the complications of pancreatitis were so severe that it jeopardised the patient’s chance for curative surgery. Rate of tumour resectability however was not affected by PEP (p=0.3).

Conclusions Patients suffering from post-ERCP pancreatitis prior to intended pancreaticoduodenectomy for periampullary cancer seem to have significantly reduced survival compared with patients with successful ERCP. A change in the management in this patient group is warranted.

Publication History

Article published online:
27 March 2025