Rise in First-Time ERCP for Benign Indications >1 Year After Cholecystectomy Is Associated With Worse Outcomes.

Area of Science:

• Gastroenterology
• Hepatology
• Biliary Medicine

Background:

• Choledocholithiasis diagnosis often relies on endoscopic retrograde cholangiopancreatography (ERCP).
• Patients with a history of cholecystectomy may still develop choledocholithiasis.
• Less invasive imaging options aim to reduce ERCP utilization.

Purpose of the Study:

• To determine the incidence, characteristics, and outcomes of patients undergoing first-time ERCP more than one year after cholecystectomy (late-ERCP).
• To analyze temporal trends in late-ERCP and biliary imaging utilization.
• To identify patient factors associated with undergoing late-ERCP.

Main Methods:

• Analysis of a commercial insurance claims database (Optum Clinformatics) from 2005-2021.
• Inclusion of adults who underwent cholecystectomy, focusing on those with late-ERCP for nonmalignant indications.
• Multivariable logistic regression to identify predictors of late-ERCP.

Main Results:

• The rate of late-ERCP increased eightfold from 2005 to 2021, despite a rise in noninvasive biliary imaging.
• Only 44% of late-ERCP procedures resulted in gallstone removal.
• High rates of post-ERCP pancreatitis (7.1%), hospitalization (13.1%), and new chronic opioid use (9.7%) were observed.

Conclusions:

• Late-ERCP rates are significantly increasing post-cholecystectomy.
• Comorbidities like gut-brain interaction disorders and metabolic dysfunction steatotic liver disease are associated with increased late-ERCP.
• Late-ERCP is linked to a disproportionately high incidence of adverse events, including new chronic opioid initiation.