S293 Impact of Prior Bariatric Surgery on Endoscopic Retrograde Cholangiopancreatography Outcomes: A Nationwide Analysis of Inpatient Morbidity, Mortality, and Resource Utilization

Introduction: Rising obesity rates increase demand for endoscopic retrograde cholangiopancreatography (ERCP) in post-bariatric surgery patients. Altered anatomy poses technical challenges, yet large-scale outcome data are limited. We compared ERCP outcomes between patients with/without bariatric surgery history. Methods: Retrospective analysis of 2019 NIS data using ICD-10 codes. Included adults undergoing ERCP. Primary outcomes: mortality, length of stay, total charges. Analyzed with STATA/SE 18.0. Results: Among 178,785 ERCP patients, 2,910 had prior bariatric surgery. The post-bariatric cohort was predominantly women (73.7%) and White (75%). Compared to non-bariatric patients, they experienced- Longer mean length of stay (5.1 vs 4.3 days), higher charges ($83,183 vs $59,550), 13.8-fold increased pancreatitis risk (adjusted odds ratio 13.8, 95% CI 9.33–20.61; P < 0.05). No significant differences in mortality or gastrointestinal bleeding. Conclusion: This largest-to-date analysis reveals post-bariatric patients face substantially higher pancreatitis risk and resource utilization after ERCP, likely due to anatomical complexity. Despite comparable mortality/bleeding rates, the dramatic pancreatitis increase demands prophylactic strategies (e.g., rectal NSAIDs). Limitations include retrospective design and coding dependencies. Enhanced prevention protocols are essential for this growing population.