S40 PSC-IBD Cohorts Show Decreased Incidence of ERCP-Associated Adverse Events Compared to Isolated PSC

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Introduction: Primary sclerosing cholangitis (PSC) is an immune-mediated, cholestatic liver disease that often coexists with Inflammatory Bowel Disease (IBD). Endoscopic Retrograde Cholangiopancreatography (ERCP) is a valuable tool in the diagnosis and treatment of PSC, though it carries risk for complications. The purpose of this study was to assess if rates of ERCP adverse events (AEs) were higher in PSC patients with IBD. Methods: Using the National Inpatient Sample (NIS) database, PSC patients 18 years or older undergoing ERCP were identified from 2008-2019 and then organized by procedural indication, therapeutic ERCP, and sphincterotomy. Patient characteristics were found using ICD-9 and ICD-10 codes. The AEs of interest were pancreatitis, cholecystitis, infection, perforation, bleeding, acute kidney injury (AKI), sepsis, mortality, length of stay (LOS), and total charges. These were analyzed using multivariate logistic or linear regression controlling for age, race, and comorbidities. Bivariate analyses were conducted using chi-square and t-tests. Analyses accounted for the complex sampling scheme of the NIS. Results: There were 284,775 PSC patients were identified as having undergone ERCP, with 0.4% (n=1,243) carrying a diagnosis of IBD. Within those undergoing therapeutic ERCP, IBD patients were more likely to have strictures (54.9% vs 38.2%, P< 0.0001), less likely to have cholelithiasis with cholecystitis (3.4% vs 17.5%, P< 0.0001) and choledocholithiasis (6.7% vs 15.8%, P=0.0004), less likely to have sphincterotomy (50.5% vs 65.9%, P< 0.0001), had a lower comorbidity index (1.05 vs 2.40, P< 0.0001), and were younger (47.6 vs 67.4 years, P< 0.0001). After adjusted logistic regression, patients with IBD were less likely to experience the adverse events of pancreatitis (OR 2.87; 95% CI 1.19-6.92), AKI (OR 9.79; 95% CI 3.12-30.69), and sepsis (OR 7.20; 95% CI 3.92-13.23). Adjusted linear regression showed patients with IBD had shorter LOS (P< 0.0001) and lower cost (P< 0.0001). Conclusion: This NIS study reveals significantly lower rates of post-ERCP complications in PSC patients with IBD which can help guide risk assessment in that population. Notably, while there were significant differences regarding procedural indication between the 2 groups, these variables were controlled for in the adjusted logistic regression (see Table 1). Table 1. - Adjusted logistic regression of therapeutic ERCPs Pancreatitis Infection Mortality AKI Sepsis Independent Variable Odds Ratio (95% CI) Odds Ratio (95% CI) Odds Ratio (95% CI) Odds Ratio (95% CI) Odds Ratio (95% CI) Without IBD 2.70 (1.01-7.22) 0.88 (0.66-1.18) 3.01 (0.42-21.57) 7.75 (2.47-24.33) 5.30 (2.89-9.73) Age 1.00 (1.00-1.01) 1.01 (1.01-1.01) 1.02 (1.02-1.02) 1.02 (1.02-1.03) 1.02 (1.02-1.03) Black 1.01 (0.85-1.18) 1.08 (1.00-1.18) 1.43 (1.19-1.72) 1.52 (1.39-1.67) 1.11 (1.01-1.22) Hispanic 1.52 (1.33-1.72) 1.04 (0.96-1.12) 0.91 (0.75-1.09) 0.94 (0.86-1.02) 1.25 (1.16-1.35) Other Race 1.53 (1.33-1.76) 1.07 (0.99-1.17) 1.23 (1.03-1.46) 0.96 (0.87-1.05) 1.34 (1.24-1.45) Unknown Race 0.88 (0.75-1.03) 1.22 (1.12-1.33) 0.98 (0.79-1.22) 0.95 (0.86-1.06) 1.11 (1.00-1.24) Male Gender 1.02 (0.94-1.10) 1.02 (0.98-1.05) 0.92 (0.83-1.02) 1.41 (1.34-1.48) 1.05 (1.01-1.10) Comorbidity Index 0.94 (0.93-0.96) 1.07 (1.06-1.08) 1.21 (1.19-1.23) 1.14 (1.13-1.15) 0.97 (0.96-0.98) Acute Pancreatitis 0.03 (0.02-0.05) 4.69 (4.39-5.01) 0.61 (0.49-0.77) 1.25 (1.16-1.34) 0.72 (0.67-0.77) Cholelithiasis w/Cholecystitis 0.85 (0.76-0.96) 1.24 (1.17-1.31) 0.30 (0.24-0.38) 0.46 (0.42-0.50) 0.20 (0.18-0.21) Choledocholithasis 0.57 (0.50-0.66) 1.06 (0.99-1.14) 0.18 (0.13-0.25) 0.32 (0.29-0.36) 0.12 (0.11-0.14) Stricture 0.61 (0.55-0.67) 0.58 (0.55-0.60) 0.56 (0.50-0.63) 0.67 (0.64-0.71) 0.46 (0.44-0.49)

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