Impact of body mass index on the incidence and severity of post-endoscopic retrograde cholangiopancreatography pancreatitis

Abdelfatah, Mohamed M.; Koutlas, Nicholas J.; Gochanour, Eric; Hamed, Ahmed; Ibrahim, Mariam; Barakat, Mohamed; Mudireddy, Prashant

doi:10.20524/aog.2019.0367

Cited by 8 publications

(7 citation statements)

References 23 publications

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“…Our finding of no significant association between the gender of the patients and development of PEP corresponds with the results from another similar studies [17,23,24].…”

Section: Discussionsupporting

confidence: 92%

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Predictive Factors for Prophylaxis Effect of Naproxen in Post Endoscopic Pancreatitis

Tanaj

Кондов

Krasniqi

2022

JMS

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Endoscopic retrograde cholangiopancreatography (ERCP) can be associated with complications like post-ERCP pancreatitis (PEP). We aimed to examine the possible influence of selective demographic and clinical factors on efficacy of periprocedural 500 mg Naproxen single dose rectal administration in prevention of PEP in patients after diagnostic or therapeutic ERCP.This randomized prospective mono-centric clinical study was implemented during January-April 2022 on 30 patients referred for ERCP at the University Clinical Center of Kosovo-Prishtina. Before ERCP, all patients received periprocedural 500mg Naproxen single dose rectal administration in prevention of PEP. The levels of amylase, lipase, and CRP were measured before ERCP, and 4/24h after.The incidence of PEP was 16,67% (5/ 30) -2 (11,76%) of the male and 3 (23,08%) of the female (p=0,4101). No significant differences between the patients without/with PEP was found related to age (p=0,8674), BMI (p=0,5591) and duration of procedure (p=0,5590). Pancreatic duct wire cannulation happened in 5 (16,67%) patients, while only 2 (40%) of them developed PEP. Amylases levels 24h after ERCP were significantly higher in patients with PEP (p=0,0005). Between patients without/with PEP there were significant differences in lipase levels before/4h/24h after ERCP for p=0,0451 vs. p=0,0278 vs. p=0,005 respectively. Related to CRP levels, no significant difference was found between the groups at any measurement time. Analyzed potential influencing factors didn't show significant influence on efficacy of Naproxen in prevention of PEP after ERCP. More extensive controlled trials are underway in Republic of Kosovo to precise the effects of Naproxen in reduction of PEP after ERCP.

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“…Our finding of no significant association between the gender of the patients and development of PEP corresponds with the results from another similar studies [17,23,24].…”

Section: Discussionsupporting

confidence: 92%

“…The PEP incidence of 16,7% in our study patients group was higher in comparison to 3-10% reported in the systematic review paper [23].…”

Section: Discussioncontrasting

confidence: 73%

Predictive Factors for Prophylaxis Effect of Naproxen in Post Endoscopic Pancreatitis

Tanaj

Кондов

Krasniqi

2022

JMS

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“…A retrospective study, including 583 patients, revealed a significantly higher PEP rate in obesity and a lower rate in normal weight 11 . However, another study, including 2235 patients, indicated that neither obesity nor low body weight increased PEP's incidence or severity 12 …”

Section: Introductionmentioning

confidence: 98%

“…11 However, another study, including 2235 patients, indicated that neither obesity nor low body weight increased PEP's incidence or severity. 12 This study aimed to investigate the effect of obesity and morbid obesity in patients undergoing ERCP by performing a three-way PSmatching analysis on both the full cohort and again on a restricted cohort that excluded smokers, alcoholics, and patients with chronic illness to avoid reverse causation.…”

Section: Introductionmentioning

confidence: 99%

Morbid obesity but not obesity is associated with increased mortality in patients undergoing endoscopic retrograde cholangiopancreatography: A national cohort study

Chen

Patel

et al. 2021

UEG Journal

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Background The relationship between body weight and outcomes of endoscopic retrograde cholangiopancreatography (ERCP) is unclear. Objectives This study aimed to investigate the impact of obesity and morbid obesity on mortality and ERCP‐related complications in patients who underwent ERCP. Methods We conducted a US population‐based retrospective cohort study using the Nationwide Readmissions Databases (2013–2014). A total of 159,264 eligible patients who underwent ERCP were identified, of which 137,158 (86.12%) were normal weight, 12,522 (7.86%) were obese, and 9584 (6.02%) were morbidly obese. The primary outcome was in‐hospital mortality. The secondary outcomes were the length of stay, total cost, and ERCP‐related complications. Multivariate analysis and propensity score (PS) matching analysis were performed. The analysis was repeated in a restricted cohort to eliminate confounders. Results Patients with morbid obesity, as compared to normal‐weight patients, were associated with a significantly higher in‐hospital mortality (hazard ratio [HR]: 5.54; 95% confidence interval [CI]: 1.23–25.04). Obese patients were not associated with significantly different mortality comparing to normal weight (HR: 1.00; 95% CI: 0.14–7.12). Patients with morbid obesity were also found to have an increased length of hospital stay and total cost. The rate of ERCP‐related complications was comparable among the three groups except for a higher cholecystitis rate after ERCP in obese patients. Conclusions Morbid obesity but not obesity was associated with increased mortality, length of stay, and total cost in patients undergoing ERCP.

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“…Despite an exhaustive review of current academic literature, an explanation for why an increased BMI may impart a greater likelihood of ERCP has not been well established in current academic literature. However, obesity has been established as an independent risk factor for developing post-ERCP pancreatitis, potentially due to a low-grade chronic inflammatory state related to a decreased level of adiponectin, an anti-inflammatory adipokine [14]. Nonetheless, it is reasonable to conclude that patient selection influences the utility of AUS following negative CTAP and may have a greater effect on management in patients with elevated BMI or advanced age.…”

Section: Discussionmentioning

confidence: 99%

The Utility of Abdominal Ultrasound Following Negative Computed Tomography in Diagnosing Acute Pancreatitis

Froes¹,

Gosal²,

Singh³

et al. 2022

Cureus

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Acute pancreatitis is a diagnosis established by fulfillment of at least two out of three clinical features, including epigastric pain, elevated lipase, and/or radiographic evidence of acute pancreatitis. Computed tomography of the abdomen and pelvis (CTAP) is the gold standard imaging modality for evaluating acute pancreatitis. Although abdominal ultrasound (AUS) is increasingly utilized given the widespread availability and high sensitivity and specificity for detecting gallstone-related complications, including gallstone pancreatitis, the leading cause of acute pancreatitis in the US. However, recent literature has concluded that performing AUS following a negative CTAP rarely led to changes in management and imparted an increased length of service (LOS) in the ED. Our study investigated whether a similar relationship was observed when managing acute pancreatitis in the inpatient setting. We aimed to quantify how performing AUS influenced inpatient LOS for patients admitted for acute pancreatitis without radiographic evidence of acute pancreatitis on CTAP. We also aimed to quantify how AUS influenced the likelihood of subsequent intervention via endoscopic retrograde cholangiopancreatography (ERCP) or cholecystectomy, including the relative impact of certain demographic or clinical features. MethodsA retrospective analysis was performed using a cohort of 6069 patient encounters extracted via the HCA Healthcare enterprise data warehouse (EDW) database. Inclusion criteria were all adult patients with an index admission for acute pancreatitis between January 1 and December 31, 2019, who underwent CTAP during admission. Patients younger than 18 years, with prior cholecystectomy, or without documentation of demographic or clinical data of interest were excluded. The primary outcome was to quantify how performing AUS within 48 hours impacted LOS for patients admitted for acute pancreatitis following negative CTAP. Secondary outcomes examined whether AUS changed management (i.e., per likelihood of subsequent ERCP or cholecystectomy). This included determining the influence of various demographic or clinical characteristics on the likelihood of intervention via ERCP or cholecystectomy. Linear regression was used to determine the effect of performing AUS on the duration of LOS. Logistic regression was used for covariate analysis based on demographic (BMI, sex, race, age) and clinical data (comorbid conditions, abnormal labs, and vital signs). ResultsPatients with acute pancreatitis who underwent AUS within 48 hours had a reduced LOS of 1.099 days. Patients who underwent AUS were 1.126 times more likely to undergo subsequent ERCP than those who received CTAP alone. Patients who received AUS following CTAP were also 2.711 times more likely to undergo subsequent cholecystectomy. Increasing age and BMI were correlated with an increased likelihood of ERCP and cholecystectomy. Males were less likely to undergo cholecystectomy (OR = 0.753) and ERCP (OR = 0.815) compared to females. ConclusionPerforming AUS within 48 hours fol...

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Impact of body mass index on the incidence and severity of post-endoscopic retrograde cholangiopancreatography pancreatitis

Cited by 8 publications

References 23 publications

Predictive Factors for Prophylaxis Effect of Naproxen in Post Endoscopic Pancreatitis

Predictive Factors for Prophylaxis Effect of Naproxen in Post Endoscopic Pancreatitis

Morbid obesity but not obesity is associated with increased mortality in patients undergoing endoscopic retrograde cholangiopancreatography: A national cohort study

The Utility of Abdominal Ultrasound Following Negative Computed Tomography in Diagnosing Acute Pancreatitis

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