Postprocedural Complications in Patients With Primary Biliary Cholangitis (PBC) Undergoing Endoscopic Retrograde Cholangiopancreatography (ERCP)

Introduction: PBC is a progressive, chronic, autoimmune disorder that can progress to cirrhosis. Endoscopic retrograde cholangiopancreatography (ERCP) is a readily available and important modality used to diagnose and evaluate the complications of PBC. There are few studies on the influence of sex, race, insurance status on mortality, hospital length of stay (LOS), and total hospital charges for patients with PBC undergoing ERCP. The objective of this study was to identify risk factors in a national population cohort (in the USA) admitted to hospitals from the years 2012- 2018. Methods: All patients aged 18 years and above with PBC undergoing ERCP were identified from the US Nationwide Inpatient Sample (NIS). Multivariate regression analysis was used to estimate the odds ratios of in-hospital mortality, the average length of hospital stay, and hospital charges, after adjusting for age, gender, race, primary insurance payer status, hospital type and size (number of beds), hospital region, hospital teaching status, and other demographic characteristics. Results: Our study identified approximately 235,794 patients who had been discharged with either PBC undergoing ERCP versus PBC without undergoing ERCP from 2012- 2018. Of these patients, the average age was 58.98 and 483 were admitted with PBC and underwent ERCP versus 235,311 patients without PBC who underwent ERCP. The analysis revealed that increases in mortality [OR 3.05 (1.94-4.77), P < 0.0001] and length of stay [OR 1.02 (1.01-1.03), P < 0.0001] were statistically significant but there was no statistically significant difference in total hospital charges [OR 1.00 (1.00-1.01), P < 0.001] for patients with PBC undergoing ERCP. Positive predictors for mortality for patients with PBC undergoing ERCP were the following: other race [OR 12.12 (1.85-79.34), HRS [OR 5.26 (1.02-27.09), P < 0.047], acute liver failure [OR 8.06 (1.98-32.70), P < 0.004] Conclusion: Patients with PBC and ERCP had higher mortality and LOS compared to patients without PBC who underwent ERCP. Factors that contributed to increased mortality included the presence of: Other race, HRS, and acute liver failure. Due to the complexity as well as high morbidity and mortality of PBC and its complications, biliary endoscopy has played an important role in evaluating PBC. ERCP continues to be the primary modality for advanced diagnostics and treatment of PBC-related complications, but it is important to recognize that there may be increased mortality and LOS for this high-risk patient group.