S229 Impact of Obesity on In-Hospital Outcomes Following Endoscopic Retrograde Cholangiopancreatography for Acute Biliary Pancreatitis and Cholangitis

Introduction: While several studies have explored various risk factors linked to complications following endoscopic retrograde cholangiopancreatography (ERCP), the impact of obesity on ERCP outcomes remains underexplored. In our study, we aimed to address this gap by comparing in-hospital outcomes of obese vs non-obese patients undergoing ERCP for acute biliary pancreatitis and acute cholangitis. Methods: We performed a retrospective cohort study using the TrinNetX database, a comprehensive multi-institutional dataset. Adult patients undergoing ERCP for biliary acute pancreatitis and acute cholangitis from 1/1/2000 to 5/30/2025 were included. Patients with any history of chronic pancreatitis, pancreatic/biliary tract malignancy, primary biliary cirrhosis, and primary sclerosing cholangitis were excluded. Patients were categorized based on whether they had a BMI of ≥30 kg/m2 vs ≤30 kg/m2. The primary aim was to assess post-ERCP complications at 1-week post-procedure. One to one propensity score matching was applied for age, gender, race, tobacco and alcohol use, comorbidities, socioeconomic status, and severity of acute pancreatitis and cholangitis. Results: Following propensity matching, a total of 10,153 patients in each group were included in the analysis. Patients with obesity had a higher risk of post-ERCP pancreatitis, respiratory failure, intubation, intensive care unit admission, sepsis, shock, and acute kidney injury as compared to patients with no obesity. Conclusion: Our study demonstrated that patients with obesity undergoing ERCP for cholangitis and biliary pancreatitis may be associated with worse clinical outcomes when compared to patients without obesity. Therefore, BMI should be an important factor to consider when performing ERCP on patients with biliary pancreatitis and cholangitis.