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POST-ERCP PANCREATITIS: DOES IT IMPACT THE OUTCOME OF WHIPPLE'S PROCEDURE?
Maha Khan
*1, Sourodip Mukharjee
2, Jessica C. Heard
2, juan malo
2, Joshua Kong
2, Prisca Mbonu
1, Houssam Osman
2, Rohan Jeyarajah
21TCU Anne Marie Burnett School of Medicine, Arlington, TX; 2Methodist Richardson Medical Center, Richardson, TX
Introduction – Patients diagnosed with pancreatic adenocarcinoma (PDAC) frequently undergo Endoscopic Retrograde Cholangiopancreatography (ERCP) for diagnostic and therapeutic purposes, such as biliary drainage. However, the occurrence of post-ERCP pancreatitis complicates their already complex treatment regimen. This condition exacerbates morbidity before surgery, precluding neoadjuvant therapy and postponing surgical intervention, often the only definitive curative option.
Methods – This study examines the interplay of clinical, procedural, and oncological factors contributing to post-ERCP pancreatitis in this vulnerable population. Conducted at a single institution, it involved 11 patients with post-ERCP pancreatitis and 20 without pancreatitis. A review of 300 PDAC patients identified those developing pancreatitis after ERCP, while 100 patients undergoing ERCP were reviewed to determine those with PDAC who subsequently developed pancreatitis. Preprocedural, intraprocedural, and post-procedural variables were analyzed, including timing of pancreatitis onset relative to ERCP, tumor location, demographics (age, BMI), clinical history (chronic pancreatitis, sphincter of Oddi dysfunction, smoking status), procedural details (bile duct cannulation attempts, stent placement, contrast use), and oncological treatments before and after tumor resection (chemotherapy, radiation). Operative variables such as surgery time, estimated blood loss, length of stay, and postoperative day 3 amylase values were also collected. Outcome variables included in-hospital and out-of-hospital complications, 30-day procedures/interventions, and mortality.
Results – The mean age of the combined cohort was 61.94 years with a higher male preponderance (M:F = 3.42:1). Average BMI was 26.96 kg/m2 during ERCP and 25.44 kg/m2 during surgery. No significant difference was observed in demographics between groups. Bile duct cannulations, contrast injections, opaque wire use, and pancreatic duct cannulations were not predictive of pancreatitis. The highest pancreatitis risk occurred within 24-48 hours post-ERCP (p < 0.001), while rectal indomethacin significantly reduced this risk (p = 0.020). Surgery was delayed in pancreatitis patients (36 days vs. 25 days). No significant differences were noted in postoperative complications, readmissions, reoperations, interventions, or mortality.
Conclusion – Time from diagnosis to surgery is critical in PDAC. ERCP-induced pancreatitis delays surgery for Whipple’s PD. Pancreatitis risk is highest within 24-48 hours after ERCP. Early identification and management of risk factors are crucial. Prophylactic measures (e.g., rectal indomethacin) and adherence to best procedural practices can minimize delays and optimize outcomes in this high-risk cohort.
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