S1589 Patients With Cystic Fibrosis Do Not Have an Increased Risk of Adverse Events After Endoscopic Retrograde Cholangiopancreatography: A Propensity-Matched Analysis

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Introduction: Cystic fibrosis (CF) is the most common life-limiting autosomal recessive disease in North America. The prevalence of biliary disease in CF varies by report, though has been cited anywhere from 15-30%. Endoscopic retrograde cholangiopancreatography (ERCP) is a useful diagnostic and therapeutic tool in hepatobiliary diseases, albeit not without risks. We aimed to investigate the safety of ERCP in CF patients using real-world data. Methods: We conducted a retrospective cohort study using the TriNetX database to identify ≥18-year-old patients with CF (CF cohort) who underwent ERCP between 2010-2024. This cohort was matched with patients undergoing ERCP who do not have CF (non-CF cohort) using 1:1 propensity score matching. Primary outcome was post-ERCP pancreatitis (PEP). Secondary outcomes included gastrointestinal bleeding, and infection. A separate subgroup analysis was conducted for patients undergoing ERCP for choledocholithiasis. Results: We identified 534 patients (mean age: 44.6± 20 years; 48.3% female) who underwent ERCP during this study period. After propensity score matching, there was no statistically significant difference in the odds of PEP between the cohorts (CF cohort: 8.3% vs. non-CF cohort: 4.9%; aOR = 1.76; 95% CI: 0.93 - 3.32, P = 0.075), bleeding (CF cohort: 3.1% vs. non-CF cohort: 2.1%; aOR = 1.52; 95% CI: 0.67 - 3.41, P = 0.31), and infection (CF cohort: 3.7 % vs. non-CF cohort: 2.4%; aOR = 1.55; 95% CI: 0.64 - 3.79, P = 0.33) (Table 1). These results were consistent across different sex and age groups. In a subgroup analysis of patients who underwent ERCP for an indication of choledocholithiasis, there was no significant difference between the CF cohort and the control cohort in rates of PEP (6.9% vs. 5.8%, aOR 1.193, 95% CI 0.482-2.951, P = 0.703), bleeding (4.6% vs. 4.6%, aOR 1, 95% CI 0.408-2.453, P = 1), or infection (9.3% vs. 5.3%, aOR 1.806, 95% CI 0.727-4.493, P = 0.198). Conclusion: Our study provides real-world evidence regarding the safety of ERCP in CF patients with comparable rates of adverse events to the general population. This is encouraging in further informing care for CF patients moving forward, though this is still an area with a paucity of research which would stand to benefit from further data and more robust, prospective studies moving forward. Table 1. - Clinical outcomes for propensity-matched hospitalizations of patients with and without cystic fibrosis that underwent endoscopic retrograde cholangiopancreatography in the United States Outcome Cohort Total number of patients with outcome Proportion of patients (%) Adjusted odds ratio (aOR) 95% confidence interval P-value Post-ERCP pancreatitis Cystic fibrosisControl 2418 8.34.9 1.763 0.937-3.315 0.075 Bleeding Cystic fibrosisControl 1510 3.12.1 1.516 0.674-3.409 0.311 Perforation* Cystic fibrosisControl 10 2.1 Not applicable Not applicable 0.001 Infections Cystic fibrosisControl 1010 3.72.4 1.554 0.638-3.785 0.328 *Patient counts <10 appear as 10 to protect personal health information, as such, the result can't be reliably interpreted in this instance.

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