Endoscopy international open · 2026
All-cause mortality, adverse events and associated factors following endoscopic retrograde cholangiopancreatography for benign indications in England.
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Kamran Umair, Harvey Philip R, Coupland Ben, Mytton Jemma, Oppong Kofi W, Trudgill Nigel
Аннотация
BACKGROUND AND STUDY AIMS: Population-based data on outcomes of endoscopic retrograde cholangiopancreatography (ERCP) for benign indications are limited. We examined the impact of changing patient demographics on ERCP outcomes.
PATIENTS AND METHODS: Adults undergoing first ERCP for benign indications between 2003 and 2020 in England were identified in Hospital Episode Statistics. All-cause mortality within 30 days and adverse event rates within 7 days were calculated. Multivariable logistic regression analysis explored factors associated with all-cause mortality.
RESULTS: A total of 283,972 patients were included; 63.4% female; median age 67 years (interquartile range 50-79). Twenty-five percent of ERCPs in 2019/2020 were performed in patients with a Charlson comorbidity score ≥ 5, compared with 8% in 2003/2004. Three percent of patients who underwent day case ERCP had an emergency readmission with pancreatitis. Thirty-day all-cause mortality fell by 31% over the study period. Mortality was associated with age (age quintile ≥ 82 years; odds ratio 19.22; 95% confidence interval [CI] 15.59-23.69 compared with 18-46 years), male sex (1.21; CI 1.14-1.27), Black or Black British ethnicity (1.42; CI 1.07-1.90), increasing comorbidity score ≥ 5 (3.35; CI 3.14-3.57), and increasing provider annual ERCP volume (volume ≥ 151; 1.08; CI 1.01-1.16). Elective ERCP (0.30; CI 0.28-0.33) and those in recent years were associated with lower mortality (2019/2020 compared with 2003/2004 (0.40; CI 0.34-0.48). Statistically significant variations in 30-day all-cause mortality were observed between ERCP providers.
CONCLUSIONS: Despite the increasing age and comorbidities of patients undergoing ERCP for benign indications, 30-day all-cause mortality fell by 31% in recent years. All-cause mortality was associated with age, males, comorbidities, black ethnicity, emergency ERCP, and increasing provider volume.
PATIENTS AND METHODS: Adults undergoing first ERCP for benign indications between 2003 and 2020 in England were identified in Hospital Episode Statistics. All-cause mortality within 30 days and adverse event rates within 7 days were calculated. Multivariable logistic regression analysis explored factors associated with all-cause mortality.
RESULTS: A total of 283,972 patients were included; 63.4% female; median age 67 years (interquartile range 50-79). Twenty-five percent of ERCPs in 2019/2020 were performed in patients with a Charlson comorbidity score ≥ 5, compared with 8% in 2003/2004. Three percent of patients who underwent day case ERCP had an emergency readmission with pancreatitis. Thirty-day all-cause mortality fell by 31% over the study period. Mortality was associated with age (age quintile ≥ 82 years; odds ratio 19.22; 95% confidence interval [CI] 15.59-23.69 compared with 18-46 years), male sex (1.21; CI 1.14-1.27), Black or Black British ethnicity (1.42; CI 1.07-1.90), increasing comorbidity score ≥ 5 (3.35; CI 3.14-3.57), and increasing provider annual ERCP volume (volume ≥ 151; 1.08; CI 1.01-1.16). Elective ERCP (0.30; CI 0.28-0.33) and those in recent years were associated with lower mortality (2019/2020 compared with 2003/2004 (0.40; CI 0.34-0.48). Statistically significant variations in 30-day all-cause mortality were observed between ERCP providers.
CONCLUSIONS: Despite the increasing age and comorbidities of patients undergoing ERCP for benign indications, 30-day all-cause mortality fell by 31% in recent years. All-cause mortality was associated with age, males, comorbidities, black ethnicity, emergency ERCP, and increasing provider volume.