Cystic Fibrosis Heterozygosity as a Risk Factor for Post-ERCP Pancreatitis: Implications for ERCP Risk Stratification...

Area of Science:

• Gastroenterology
• Genetics
• Pancreatology

Background:

• Endoscopic retrograde cholangiopancreatography (ERCP) is a common procedure with a known risk of post-ERCP pancreatitis (PEP).
• Cystic fibrosis (CF) affects hepatobiliary health, and its impact on PEP risk is not fully understood.
• CF transmembrane conductance regulator (CFTR) biology is implicated in pancreatic function.

Purpose of the Study:

• To investigate whether cystic fibrosis (CF) heterozygosity increases the risk of post-ERCP pancreatitis (PEP).
• To identify CF carriers as a potentially high-risk group for PEP following ERCP.

Main Methods:

• Retrospective analysis of 364,707 patients undergoing ERCP from the Epic Cosmos cohort.
• CF carrier status identified using diagnostic codes.
• PEP defined as non-gallstone pancreatitis within 14 days post-ERCP.
• Multivariable logistic regression and entropy balancing used for statistical adjustment.

Main Results:

• CF carrier patients had a higher unadjusted PEP rate (40.4% vs. 11.3%).
• After adjustment, CF carrier status remained associated with significantly increased PEP risk (adjusted OR = 2.34 and 2.13).
• CF carriers undergoing ERCP were more likely to be female, older, and receive rectal indomethacin.

Conclusions:

• CF heterozygosity is an independent risk factor for substantially increased PEP risk.
• CFTR dysfunction may enhance pancreatic vulnerability during ERCP.
• CF carriers may benefit from enhanced pre-procedural risk assessment and optimized prophylactic strategies for PEP.