DDW 2022 Author Disclosures
Briette Karanfilian: NO financial relationship with a commercial interest | Amy Tyberg: YES financial relationship with a commercial interest;Boston Scientific:Consulting;Ambu Inc:Consulting;EndoGastric Solutions:Consulting | Avik Sarkar: NO financial relationship with a commercial interest | Haroon Shahid: NO financial relationship with a commercial interest | Alexa Simon: NO financial relationship with a commercial interest | Karoline Reinoso: No Answer. | Amol Bapaye: NO financial relationship with a commercial interest | Ashish Gandhi: NO financial relationship with a commercial interest | Harshal Gadhikar: NO financial relationship with a commercial interest | Shivangi Dorwat: NO financial relationship with a commercial interest | Hameed Raina: NO financial relationship with a commercial interest | Jaseem Ansari: NO financial relationship with a commercial interest | Jose Nieto: YES financial relationship with a commercial interest;Boston Scientific:Consulting | Nadim Qadir: NO financial relationship with a commercial interest | Maria Porfilio: NO financial relationship with a commercial interest | Martha Arevalo-Mora: NO financial relationship with a commercial interest | Miguel Puga-Tejada: NO financial relationship with a commercial interest | Juan Alcivar-Vasquez: NO financial relationship with a commercial interest | Carlos Robles-Medranda: YES financial relationship with a commercial interest;Pentax Medical:Consulting;Micro-tech:Consulting;Conmed:Consulting;Boston Scientific:Consulting;Steris:Consulting;Medtronic:Consulting;Motus:Consulting;G-Tech Medical Supply:Consulting;CREO Medical:Consulting;EndoSound:Consulting;Mdconsgroup:Consulting | Jose Celso Ardengh: NO financial relationship with a commercial interest | Romy Bareket: NO financial relationship with a commercial interest | Kelvin Liao: NO financial relationship with a commercial interest | Roohi Patel: NO financial relationship with a commercial interest | Sophia Pimpinelli: NO financial relationship with a commercial interest | Monica Gaidhane: NO financial relationship with a commercial interest | Michel Kahaleh: YES financial relationship with a commercial interest;BSC:Grant/Research Support;BSC:Grant/Research Support;Medtronic:Grant/Research Support;Medtronic:Consulting;Microtech:Consulting;Microtech :Grant/Research Support;Conmed:Grant/Research Support;Cook:Grant/Research Support;Olympus:Grant/Research Support;ERBE :Grant/Research Support;GORE:Grant/Research Support;Emcision:Grant/Research Support;Abvvie :Consulting
Background
Viral infections are known to have effects on the pancreato-biliary system, however there is limited data showing that the same is true of COVID-19. Endoscopic retrograde cholangiopancreatography (ERCP) can safely be performed in patients with COVID-19 infection, but outcomes of patients with COVID-19 infections and concomitant pancreatic and biliary disease requiring endoscopic intervention are unknown. This study aims to evaluate if pancreaticobiliary diseases and post-ERCP outcomes are more severe in patients with COVID-19.
Methods
Patients with pancreato-biliary disease that required inpatient ERCP from five centers in the United States and South America between January 1, 2020 and October 31, 2020 (during the COVID pandemic) were included in a dedicated registry. A representative cohort of patients from each month were randomly selected from each site. Patients were separated by pre-procedure COVID status. Disease severity and post-ERCP outcomes were compared between COVID-19 positive and COVID-19 negative patients. All statistical analysis was performed using STATA software.
Results
A total of 175 patients were included: 95 COVID-positive, 80 COVID-negative (Table 1). Mean CTSI score for the subset of patients who had pancreatitis was higher in COVID positive cohort by 3.2 points (p < .00001). The COVID positive group had more cases with severe disease (n=41) compared to the COVID negative group (n=2) (p < .00001) (Table 2). Length of hospital stay following ERCP was higher in COVID positive cohort by 21.4 days (p < .00001).
Mortality was higher in the COVID-19 positive group (19%) compared to COVID negative group (7.5%) even though the COVID-19 negative group had higher incidence of malignancy (n=17, 21% vs n=7, 7.3%) (p = 0.0455).
Conclusion
There is limited data on the effects of COVID-19 infection on pancreatobiliary disease characteristics and outcomes following ERCP. This study shows that patients with COVID infection have more severe pancreato-biliary disease and worse post-ERCP outcomes, including longer length-of-stay and higher mortality rate. These are important considerations when caring for these patients and planning for endoscopic intervention.
Table 1.
Demographic information and disease severity
| COVID Negative (n=80) | COVID Positive (n= 95) | ||
|---|---|---|---|
| Age (mean) | 61.0 | 56.2 | |
| Male | 62.5% (SO) | 47.4% (45) | |
| Female | 37.5% (30) | 52.6% (SO) | |
| Comorbidities | Hypertension | 48.8% (39) | 5.3%(5) |
| Obesity | 5.0%(4) | 15.8% (15) | |
| Malignancy | 21.3% {17) | 7.4%{7) | |
| Diabetes | 25.0% (20) | 24.2%(23) | |
| Indication for ERCP | Biliary | 71.3% (57) | 50.5% (48) |
| Pancreatitis | 28.8% (23) | 49.5% (47) | |
| CTSI for patients with pancreatitis (mean} | 2.8 | 6 | |
| Overall disease severity | Mild | 11.3% (9) | 0.0%(0) |
| Moderate | 86.3% (69) | 56.8% (54) | |
| Severe | 2.5%{21 | 43.1% {41) | |
Table 2.
Outcomes after ERCP
|
Technical success |
COVID Negative {n=S0} |
COVID Positive {n= 95} |
|---|---|---|
| 100% (80) | 100% (80) | |
| Clinical success (resolution of indication for endoscopic intervention) | 92.3% (72/78) | 84.6% (66/78) |
| ASGE ERCP Grade (1 to 4} | 2.3 | 1.7 |
| Concurrent enteral feeding | 11.3% (9) | 36.8% (35) |
| Mean total number of ERCPs patient underwent | 2.25 | 1.10 |
| Mean length of stay from procedure to discharge {days) | 8.33 | 29.7 |
| Mortalitv | 7.5%{6} | 19.0% (19} |
CONTROL ID: 3700468