Adverse Events Associated with ERCP in a Predominantly Black Urban Population

Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) has an overall complication rate of 6.9% to 12%. There is a paucity of literature on post-ERCP complications in the Afro-Caribbean and African-American population that comprises greater than 80% of our patient population. The aim of this study was to determine the frequency of post-ERCP complications in a predominantly black urban population. Methods: Retrospective review of all ERCP cases performed at two academic medical centers from 2007 to 2017. The main outcomes were post-ERCP complications (pancreatitis, perforation, infection, hemorrhage, cardiopulmonary events, all-cause mortality) within 30 days of the procedure. Complications were defined and classified according to consensus criteria1. Results: Of 1,075 cases reviewed 927 had documented ethnicity and birthplace. 792 (85.4%) were black, of which 475 (51.2) were Afro-Caribbean, 301 (32.5%) were African-American, and 16 (1.7%) were African-born. Of 1,075 cases, 682 (63.4%) were female, mean age of all subjects was 56.7 years, and 100 (9.3%) patients experienced a total of 124 complications (Table 1). Of the 146 ASA class IV patients, 25 experienced a complication while 121 did not (p = 0.0005). Of the 11 ASA class V patients, 3 experienced a complication while 8 did not (p = 0.04). Of the 12 patients with a prior history of post-ERCP pancreatitis (PEP), 5 experienced a complication while 7 did not (p = 0.0001). Eighteen (1.7%) patients experienced PEP. Sixteen (1.5%) patients had hemorrhage. Thirty-six (3.3%) patients experienced an infection. Seven (0.7%) patients had a perforation while 22 (2.1%) had a cardiopulmonary event. Twenty-five (2.3%) patients died within 30 days though only 3 cases were directly related to the ERCP while the rest were multifactorial and related to co-morbidities (Table 2). Conclusion: Outcomes of ERCP in a predominantly Afro-Caribbean and African-American population demonstrate a lower incidence of PEP (1.7% vs. 3%-10%) and all-cause 30-day mortality (2.3% vs. 5%) when compared to previously reported incidence rates1,2. Additionally, it appears that a higher ASA class and a prior history of PEP are risk factors for the development of post-ERCP complications though larger studies will be required for validation.27_A Figure 1. Patient Demographics27_B Figure 2. Complication Rates