Incidence and Predictors of Incidental Biochemical and Radiologic Pancreatic Alterations Following Uncomplicated ERCP

Millie Chau; Sunil Samnani; Fateh Bazerbachi; Anirudh Mirakhur; Yibing Ruan; Megan Howarth; Sydney Bass; Martin J Cole; Yang Lei; Suqing Li; Christian Turbide; Rachid Mohamed; Darren R Brenner; Steven J Heitman; B Joseph Elmunzer; Nauzer Forbes

doi:10.3390/jcm12062230

Incidence and Predictors of Incidental Biochemical and Radiologic Pancreatic Alterations Following Uncomplicated ERCP

J Clin Med. 2023 Mar 13;12(6):2230. doi: 10.3390/jcm12062230.

Authors

Millie Chau¹, Sunil Samnani¹, Fateh Bazerbachi², Anirudh Mirakhur³, Yibing Ruan^{4

5}, Megan Howarth¹, Sydney Bass¹, Martin J Cole¹, Yang Lei¹, Suqing Li¹, Christian Turbide¹, Rachid Mohamed¹, Darren R Brenner^{4

6}, Steven J Heitman^{1

6}, B Joseph Elmunzer⁷, Nauzer Forbes^{1

6}

Affiliations

¹ Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada.
² CentraCare, Interventional Endoscopy Program, St. Cloud Hospital, St. Cloud, MN 56303, USA.
³ Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada.
⁴ Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada.
⁵ Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Calgary, AB T5J 3E4, Canada.
⁶ Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada.
⁷ Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, SC 29425, USA.

Abstract

Background: Despite post-ERCP pancreatitis (PEP) being a major focus of outcomes research in endoscopic retrograde cholangiopancreatography (ERCP), little is known regarding the frequency with which asymptomatic biochemical and/or radiologic pancreatic alterations occur in patients following ERCP.

Methods: Adult inpatients undergoing ERCP were identified from a prospective ERCP registry. Patients with any abdominal pain, confirmed PEP, or pancreatitis or abnormal pancreatic enzymes preceding ERCP were excluded. Primary outcomes were asymptomatic lipase elevation on bloodwork within 24 h of ERCP or asymptomatic cross-sectional imaging findings consistent with acute pancreatitis in the absence of clinical PEP within 14 days. Multinomial logistic regression and multiple logistic regression were used to examine associations between exposures and lipase levels and between PEP or imaging findings, respectively.

Results: In total, 646 and 187 patients were analyzed as part of the biochemical and radiologic cohorts, respectively. A total of 26.0% of patients had asymptomatic elevations in lipase above the upper limit of normal (ULN) within 24 h, and 9.4% had elevations >3× ULN. A total of 20.9% of patients had incidental findings of enlargement, inflammation/edema/fat stranding, peri-pancreatic fluid collections, and/or necrosis on cross-sectional imaging within 14 days. Pancreatic contrast injection was associated with higher odds of asymptomatic lipasemia (adjusted odds ratio, AOR, 7.22; 95% confidence intervals, CI, 1.13 to 46.02), as was the use of the double-wire technique (AOR 15.74; 95% 1.15 to 214.74) and placement of a common bile duct stent (AOR 4.19; 95% CI 1.37 to 12.77). Over 10 cannulation attempts were associated with the presence of one or more radiologic finding(s) (AOR 33.95; 95% CI 1.64, to 704.13).

Conclusions: Significant rates of incidental biochemical and/or radiologic pancreatic abnormalities are present following ERCP. Clinicians should be aware of our findings to minimize misclassification and better direct healthcare utilization.

Keywords: ERCP; health resources; lipase; pancreatitis; radiology.

Grants and funding

This research received no external funding.