Outcomes and timing of endoscopic retrograde cholangiopancreatography for acute biliary pancreatitis

Background: Indication of endoscopic retrograde cholangiopancreatography (ERCP) in acute biliary pancreatitis (ABP) is challenging. Aims: In this retrospective study, we analyzed real-world data to understand the ERCP practice in ABP in Hungarian centers. Methods: Clinical data on ABP patients (2013-2015) were extracted from our large multicentric database. Outcomes, quality indicators and the role of early timing of ERCP (<24 h from admission) were analyzed. Results: There were 356 patients with ABP. ERCP was performed in 267 (75%). Performance indicators of ERCP proved to be suboptimal with a biliary cannulation rate of 84%. Successful vs unsuccessful cannulation of naive papilla resulted in lower rates of local [22.9% vs 40.9%, (P=0.012)] and systemic [4.9% vs 13.6%, (P=0.042)] complications. Successful vs unsuccessful clearance resulted in lower rates of local complications [22.5% vs 40.8%, (P=0.008)]. Successful cannulation and drainage correlated with less severe course of ABP [3.6% vs 15.9%, (P=0.001) and 4.1% vs 12.2%, (P=0.033)] respectively. A tendency of an increased rate of local complications was observed if ERCP was performed later [<24 h: 21.1% (35/166); between 24-48 h: 23.4% (11/47); >48h: 37.2% (16/43) (P=0.088)]. Conclusion: Optimization of ERCP indication in ABP patients is critical as suboptimal ERCP practices in ABP without definitive stone detection are associated with poorer clinical outcomes. (C) 2019 Published by Elsevier Ltd on behalf of Editrice Gastroenterologica Italiana S.r.l.