P2859 - Long-Term Outcomes of ERCP in the Management of Chronic Pancreatitis Over a 10-year Period at a Tertiary Care Center

Ikenna K. Emelogu, MD¹, Carolyn G. Brooks, MD¹, Smit Deliwala, MD¹, Lucie F. Calderon, MD¹, Fiyinfoluwa O. Abraham, MD¹, Vishnu Ravi Kumar, MPH¹, Field Willingham, MD, MPH², Steven Keilin, MD¹, Vaishali Patel, MD¹, Jordan Orr, MD¹, Walter Park, MD³, Saurabh Chawla, MD, FACG^1
1Emory University School of Medicine, Atlanta, GA; ²Emory University, Atlanta, GA; ³Stanford University, Palo Alto, CA

Introduction: Long-term data on the use of ERCP for chronic pancreatitis (CP) is scarce. The aim of this study was to evaluate the long-term outcomes of ERCP in the management of CP over a 10-year period at our tertiary care center.

Methods: We retrospectively identified all patients who underwent ERCP for complications of CP between 1/1/2011 and 12/31/2021. Patients with pancreatic malignancy or less than one year of follow-up were excluded. Clinical success was defined as reported improvement in pain for at least one year after ERCP (with or without opioid use). Patient demographics, procedural data, surgical data, adverse events, and follow-up data were reviewed.

Results: Of 435 patients who underwent ERCP for complications of CP, 97 patients (male, 60%) met inclusion criteria (most were excluded due to < 1 year follow-up). Patients were followed for a median duration of 40.5 months (range 12—145). The most common etiologies of pancreatitis were alcohol (n=28; 28.9%), idiopathic (n=28; 28.9%), and gallstones (n=18; 18.6%). The chief complaint at index ERCP was abdominal pain (n=74; 76.3%) in most patients, followed by nausea/vomiting (n=23; 23.7%). Most common indications for ERCP included pancreatic duct (PD) leak/disruption (n=25, 25.8%), PD strictures (n=9, 9.3%), PD stones (n=10, 10.3%), and biliary strictures (n=24, 24.7%). Eighty-four patients (86.6%) required repeat ERCPs (median 4, range 1—17). A median of 2 consecutive repeat ERCPs (defined as ERCPs performed within 3 months from prior, or stent in place from prior) were required after the index for the above indications. Repeat ERCP (non-consecutive) was required within 1 year after a stent-free trial in 24% (n=20) of patients, primarily in those with biliary strictures (20%) and PD leak/disruption (15%). Technical success was 75.3% (n=73) and clinical success after ERCP was achieved in 60.8% (n=59). The adverse event rate was 11% (n=11), most commonly abdominal pain (73%). Death occurred in 5 patients; however, only one was related to sequelae of CP. Twenty patients (20.6%) required surgery after ERCP(s), for which clinical success was 79.4%.

Discussion: The use of ERCP for CP over a span of several years led to suboptimal technical and clinical success rates (with or without opioid use), but with a low rate of adverse events. After a stent-free trial, 24% of patients required repeat ERCPs within one year despite initial resolution of symptoms, most commonly for biliary strictures and PD leak, and less so for PD strictures or PD stones.


Disclosures:


Ikenna K. Emelogu, MD¹, Carolyn G. Brooks, MD¹, Smit Deliwala, MD¹, Lucie F. Calderon, MD¹, Fiyinfoluwa O. Abraham, MD¹, Vishnu Ravi Kumar, MPH¹, Field Willingham, MD, MPH², Steven Keilin, MD¹, Vaishali Patel, MD¹, Jordan Orr, MD¹, Walter Park, MD³, Saurabh Chawla, MD, FACG¹. P2859 - Long-Term Outcomes of ERCP in the Management of Chronic Pancreatitis Over a 10-year Period at a Tertiary Care Center, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.