Patient-reported tolerability of endoscopic retrograde cholangiopancreatography using conscious sedation in patients with underlying depression and anxiety.

BACKGROUND

Endoscopic retrograde cholangiopancreatography (ERCP) is often performed under conscious sedation, which may increase pain and dissatisfaction. Mental health conditions may influence patient-reported experience measures (PREMs), including tolerability. This study explores the association between pre-existing anxiety and/or depression and ERCP tolerability using the validated Patient-Reported Scale for Tolerability of Endoscopic Procedure (PRO-STEP) to address this.

METHODOLOGY: We performed a retrospective analysis of prospectively maintained data from an international observational cohort of adult patients undergoing ERCP. Pre-existing anxiety/depression were identified prior to the index procedure and the PRO-STEP questionnaire was used to evaluate peri- and post-procedure outcomes. Univariable and multivariable logistic regressions examined the associations between pre-operative anxiety/depression and peri- and post-operative tolerability and patient-reported health outcomes.

RESULTS

Among 3,714 participants, 13% had anxiety and/or depression. The mean age of participants in the control group was 62.3 ± 17.4 years, and 49.9% were female, while in the group with depression and/or anxiety, the mean age was 60.0 ± 16.4 years and 68.3% were female (p < 0.001). Common bile duct stones were the most common indications for ERCP in both groups (41.6% of controls and 42.4% of the depression/anxiety group, p = 0.10). Patients in the depression/anxiety group reported higher rates of opioid use (23.4% vs. 13.8%, p < 0.001), cannabis use (22.8% vs. 10.5%, p < 0.001), and heavy alcohol consumption (5.0% vs. 3.6%, p < 0.001). There were no statistically significant differences between groups in terms of disposition, comorbidities, or procedural parameters. Underlying anxiety and/or depression was significantly associated with increased intra-procedural awareness score > 3 (odds ratio, OR, 1.55, 95% CI 1.23-1.95) and discomfort score > 6 (OR 1.73, 95% CI 1.23-2.43) and with post-procedural scores > 3 for abdominal pain (OR 1.44, 95% CI 1.08-1.93), nausea (OR 2.03, 95% CI 1.43-2.89), and distension (OR 2.12, 95% CI 1.29-3.50).

CONCLUSIONS

Patients with pre-existing anxiety and/or depression reported significantly worse tolerability of ERCP under conscious sedation. Although further research is needed in this area, staff in gastrointestinal endoscopy units should consider strategies aimed at improving tolerability and, consequently, satisfaction among vulnerable populations.