BACKGROUND AND STUDY AIMS: Post-ERCP pancreatitis (PEP) is the most common and serious complication of ERCPs. Our aim was to estimate the nationwide incidence, temporal trends and mortality of PEP and establish its risk-factors in the United States. METHODS: This was a retrospective cohort study analyzing the Nationwide Inpatient Sample (NIS) data from 2011 to 2017 using ICD codes. The primary outcomes were to assess the trends of post-ERCP pancreatitis (PEP) and the predictors of occurrence of PEP. Secondary outcomes were in-hospital mortality, length of stay and ICU admission. RESULTS: Of the 1,222,467 adult patients who underwent inpatient ERCP during the study period, 55,225 (4.5%) developed post-ERCP pancreatitis. The hospital admission rate of PEP increased by 13.3% from 7,735 in 2011 to 8,920 in 2017 (OR 1.23, 95% CI 1.04-1.46; p = 0.016). The overall rate of mortality increased from 2.75% of PEP cases in 2011 to 4.38% in 2017 (OR: 1.62, 95% CI 1.10-2.38, p = 0.014). Multiple patient-related (alcohol use, cocaine use, obesity, chronic kidney disease, heart failure), procedure-related (therapeutic ERCP, sphincterotomy, pancreatic duct stent placement, sphincter of Oddi dysfunction) and hospital-related factors (teaching hospitals, hospitals located in West and Mid-west) that impact the occurrence of PEP were identified. CONCLUSIONS: Our study shows a rising hospital admission rate and mortality associated with PEP in the United States. This calls for a greater recognition of this life-threatening complication and amelioration of its risk-factors, whenever possible.

Gastrointestinal (GI) symptoms are common in systemic lupus erythematosus (SLE) but are usually attributable to medication side effects, infections, or other underlying conditions. In rare cases, they are caused by the autoimmune process itself. In this report, we present two cases of lupus enteritis as the sole manifestation of lupus flare. We also provide a comprehensive review of available literature on this topic with a specific focus on clinical symptoms, complications, laboratory findings, histology, imaging findings, and therapies. Lupus enteritis is an uncommon manifestation of SLE. CT scan of the abdomen is the diagnostic modality of choice. The three major CT findings are target sign, comb sign, and increased mesenteric fat attenuation. Ascites is also commonly present. Corticosteroids and second-line immunosuppressants have been successfully employed in the treatment of lupus enteritis. Our cases highlight this unusual manifestation as the only symptom of active SLE. A high index of suspicion should be maintained when evaluating SLE patients presenting with GI symptoms to prevent diagnosis and treatment delays that could lead to serious complications such as bowel necrosis, perforation, and even death.

We aimed to conduct a systematic review and meta-analysis on the efficacy and safety of primary needle-knife fistulotomy (NFK) in biliary cannulation. An electronic bibliographic search of digital dissertation databases was performed from inception till March 2020. All prospective studies, including randomized trials evaluating the use of NFK as a primary cannulation technique in biliary cannulation, were analyzed. The primary outcome was a successful cannulation rate and the secondary outcomes were post-ERCP pancreatitis rate and overall post-ERCP complication rate. A total of four prospective studies, including three randomized trials, were included for the analysis. The pooled cannulation success rate for primary NFK was 95.7% (95% CI. 83.1–99.0, P < 0.001). When compared with standard wire-guided cannulation, the analysis did not show any difference between the two techniques in terms of cannulation success (OR, 3.59, 95% CI, 0.34–37.39; P = 0.28; low certainty of evidence). The overall rate of post-ERCP pancreatitis with primary NFK was 1.5 % (95% CI, 0.6–3.9, P < 0.001). When compared with conventional wire-guided technique, the odds of developing post-ERCP pancreatitis with NFK were 0.22 (95% CI, 0.04–1.04, P = 0.06; moderate certainty of evidence). To conclude, NKF seems to be an effective means of biliary cannulation in expert hands. Although it may be associated with a lower rate of post-ERCP pancreatitis, the current strength and quality of evidence to support its use as a primary cannulation strategy is low. It may be considered in ERCPs at higher risk of pancreatitis by experienced endoscopists.

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Introduction: Obesity is reportedly associated with worse outcome in patients with acute pancreatitis (AP). However, AP has varying etiologies. Hypertriglyceridemia induced acute pancreatitis (HTGP) has sociodemographic variations compared to AP from biliary stones or alcohol. This study aimed to determine the impact of obesity on outcomes of patients with HTGP. Methods: This was a retrospective cohort study of the combined Nationwide Inpatient Sample database for 2016 and 2017. Hospital discharges of patients 18 years and over with HTGP were included. This cohort was divided based on presence of comorbid obesity into three groups- patients without obesity, mild-moderate obesity (MMO) (BMI: 30.0 - 39.9) and morbid obesity (MO) (BMI &gt;=40.0). Primary outcome was inpatient mortality. Secondary outcomes included length of hospital stay (LOS), total hospital charges (THC), discharge diagnoses of hypocalcemia, sepsis, septic shock, acute renal failure (AKI) and acute respiratory failure (ARF). Multivariate regression analysis was used to adjust for patients’ sociodemographic factors, Charlson comorbidity index as well as hospital characteristics as confounders. Results: A total of 104,465 hospitalizations were principally for HTGP, accounting for 18.2% of patients with acute pancreatitis during the study period. Of the patients with HTGP, 13.7% and 10.9% of these patients classified as having MMO and MO respectively. Patients with obesity were significantly younger than patients without obesity. In patients with MO, there was higher odds of mortality (aOR=1.83, 95% CI: 1.090 – 3.083, p=0.022), while there was no difference in mortality in patients with MMO (aOR 1.09 95% CI: 0.609 – 1.940, p=0.777), both compared with patients without obesity. Patients with MO had increased mean LOS of 0.5 days (95% CI: 0.3 – 0.7, p&lt;0.001) as well as increased THC of $3977 (95% CI: 1467 – 6487, p=0.002) compared to those without obesity. There was no difference in mortality, THC and LOS in patients with MMO. Morbidly obese patients also had increased odds of septic shock (aOR=2.27, 95% CI: 1.297 – 3.972, p=0.007), AKI (aOR=1.28, 95% CI: 1.120 – 1.459, p&lt;0.001), and ARF (aOR=1.94, 95% CI: 1.491 – 2.524, p&lt;0.001). Conclusion: Morbid obesity is associated with higher mortality and poor outcomes in patient with hypertriglyceridemia induced pancreatitis.