Impacts of obesity on the outcomes of endoscopic retrograde cholangiopancreatography: A propensity score-matched analysis.

BACKGROUND AND STUDY AIMS: Technical challenges posed by endoscopic retrograde cholangiopancreatography (ERCP) in obese patients are often reflected in longer fluoroscopy and procedure times, which could impact the outcomes of ERCP. This study aims to explore how obesity influences the outcomes of ERCP.

PATIENTS AND

METHODS

Medical records of patients with a naïve papilla who underwent ERCP between 2021 and 2024 were retrospectively reviewed. Patients were classified into two groups based on body mass index (BMI): non-obese (BMI < 30) and obese (BMI ≥ 30). A 1:1 propensity score matching was performed regarding age, sex, comorbidities, indication, papilla morphology, and cannulation technique. Adverse events, cannulation time and success, and stone clearance were compared between the groups.

RESULTS

Of the total 1351 patients, 294 patients were finally included (147 in each group). In the full cohort, procedure stop due to sedation-related adverse events occurred more frequently in the obese group (6.9% vs. 3.3%, p-value = 0.028). In the matched cohort, there was no significant difference in the rate of post-ERCP pancreatitis in obese and non-obese groups (10.2% vs. 17.7%, p-value = 0.06). Stone clearance was achieved in 82.8% and 73.3% of obese and non-obese groups, respectively (p-value = 0.12). There was no significant difference between the groups regarding cannulation time and success (p-value>0.05). Multivariate analysis revealed that BMI was not associated with either PEP (odds ratio = 0.94, 95% confidence interval: 0.87-1.01) or stone clearance success (odds ratio = 0.95, 95% confidence interval: 0.91-1.03).

CONCLUSIONS

Obesity does not appear to be associated with cannulation challenges, procedure success, and post-ERCP adverse events, although sedation-related adverse events occur more frequently in these patients. However, given the limited sample size, the study may be underpowered to detect modest effects, particularly in patients with BMI ≥35 kg/m2.