S2229 Is ERCP Safer in Bariatric Surgery Patients? A Nationwide Analysis

Introduction: Obesity is a global health issue, and bariatric surgery, especially Roux-en-Y gastric bypass, is a common treatment. The altered anatomy caused by bariatric surgery complicates traditional ERCP. Comparative data on ERCP outcomes, particularly post-ERCP pancreatitis (PEP), in bariatric vs non-bariatric patients remain limited. This study assesses ERCP safety and adverse event rates in patients with prior bariatric surgery. Methods: We analyzed Nationwide Inpatient Sample data from 2016–2019. Patients undergoing inpatient ERCP were identified via ICD-10 procedural codes. Outcomes included mortality, length of stay (LOS), hospital charges, and adverse events (PEP, bleeding, perforation, infections). Multivariable logistic regression adjusted for demographics, comorbidities, and procedure types to assess PEP risk factors. Analyses were performed using SPSS, with significance set at P < 0.05. Results: The study included 366,700 controls and 4,540 patients with prior bariatric surgery. Bariatric surgery patients were younger (mean age 55.44 vs 63.14 years, P < 0.001) and predominantly woman (76.2% vs 56.6%, P < 0.001). A higher proportion of bariatric surgery patients were obese (41.7% vs 16.9%, P < 0.001) and privately insured (44.4% vs 26.8%, P < 0.001). They had lower Charlson Comorbidity Index scores (P < 0.001) and were more likely to undergo diagnostic ERCP (14.2% vs 12.6%, P = 0.001). Regarding outcomes, bariatric surgery patients had shorter length of stay (4.81 vs 5.13 days, P < 0.001) and similar total charges (P = 0.545). Mortality rates were lower in the bariatric group (0.9% vs 1.2%, P = 0.038), but this was not statistically significant after adjustment (aOR 1.30, 95% CI 0.92–1.82, P = 0.135). Bariatric patients had reduced risk of post-ERCP pancreatitis (aOR 0.75, 95% CI 0.60–0.93, P = 0.009), while rates of post-ERCP infection, bleeding, and perforation were similar between groups. Conclusion: Bariatric patients undergoing ERCP had shorter hospital stays and fewer adverse events, including PEP and infections, compared to non-bariatric controls. Although bariatric surgery independently reduced PEP risk, it did not significantly influence post-ERCP mortality or infections. The protective effect of bariatric surgery against PEP may be attributed to anatomical changes, improved metabolic profiles, and refined perioperative care. Further research is warranted to elucidate the mechanisms and evaluate long-term outcomes in this population.