Response:

Abstract

In their recent observational study, Zhao et al 1 found similar incidence rates of post-ERCP pancreatitis (PEP) in patients with chronic pancreatitis (CP) versus other biliary diseases, and they reported lower PEP incidence rates as the severity of CP increased. The authors state that they "identified other possible risk and protective factors not examined before. The reduced incidence of PEP in CP patients was correlated with the presence of diabetes mellitus, pancreatic stones, and the use of ESWL (extracorporeal shock wave lithotripsy)." We would like to point out that our group had formerly evaluated the influence of type 2 diabetes mellitus (T2DM) on the short-term adverse events after ERCP in an 11-year (2003-2013) observational study that included 126,885 therapeutic procedures (23,002 [18.1%] in people with T2DM) in the overall Spanish population. 2 We found lower crude incidence rates of PEP in people with T2DM than in people without T2DM (15.9% vs 18.3%, respectively). We additionally described decreasing numbers of PEP over time, but this trend reached statistical significance only for people without T2DM. In our study, T2DM was associated with lower in-hospital mortality after an endoscopic biliary sphincterotomy (odds ratio [OR] Z 0.82 [0.74-0.92]). Last, time trend analyses from 2003 to 2013 showed significant reductions in in-hospital mortality over time only in people with T2DM (OR Z 0.97 [0.94-1.00]). Despite some methodologic limitations inherent in observational studies, we believe that it is worth remembering our results at this point. 3 DISCLOSURE All authors disclosed no financial relationships relevant to this publication.