S273 Does Endoscopic Retrograde Cholangiopancreatography Worsen Outcomes in Sterile Necrotic Acute Pancreatitis? Insights From a Real-World 90-Day Analysis

Introduction: The implications of endoscopic retrograde cholangiopancreatography (ERCP) in the management of acute pancreatitis (AP) with sterile necrosis are not well established. While ERCP is indicated in cases of infected necrosis or biliary obstruction, its utility in sterile necrosis is less defined. Objective: To evaluate the clinical outcomes of ERCP in patients with AP and sterile necrosis compared to those managed conservatively. Methods: We conducted a retrospective propensity score–matched cohort study using the TriNetX Global Collaborative Network. Adults (≥18 years) with a diagnosis of acute pancreatitis and radiographically confirmed sterile necrosis were identified. Patients were divided into 2 matched cohorts: those who underwent ERCP (n = 831) and those who did not undergo ERCP (n = 831). Individuals with infected necrosis, chronic pancreatitis, or any ERCP procedure in the control group were excluded. Outcomes were assessed over 180 days following the index diagnosis. Analyses included risk differences, hazard ratios, and Kaplan-Meier survival estimates. Results: In matched cohorts (n = 831 each), mortality rates were slightly higher in the ERCP group (13.2% vs 11.8%; risk difference 0.014 [95% CI: -0.017, 0.046]; P = 0.374), with similar survival at 180 days (84.8% vs 86.6%; HR: 1.092 [95% CI: 0.832, 1.434]; P = 0.524). Rates of sepsis were slightly lower in the ERCP group (6.9% vs 8.3%; P = 0.266), with comparable survival (92.3% vs 90.7%; HR: 0.802; P = 0.217). Hospital visits occurred in 20.6% of ERCP patients vs 18.4% controls (P = 0.265). Infected necrosis was rare (1.2% vs 1.8%) and did not differ significantly between groups (P = 0.314), although Kaplan-Meier analysis showed a statistically significant survival benefit in the ERCP group (99.5% vs 98.0%; HR: 0.256 [95% CI: 0.085, 0.771]; P = 0.009). Conclusion: In patients with AP and sterile necrosis, ERCP was not associated with significant differences in mortality, sepsis, or hospitalization rates. However, a potential survival benefit was observed regarding the development of infected necrosis. Further prospective studies are warranted to clarify the implications of ERCP in this patient population.