S2165 Cannabis Use Does Not Increase the Risk of Post-Procedural Outcomes in Patients Undergoing ERCP or EUS: A Propensity Score-Matched Analysis

Introduction: Cannabis use is increasingly recognized for its complex effect on gastrointestinal function and inflammation. Despite the rising prevalence of cannabis use among patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) or endoscopic ultrasound (EUS), there is a lack of clinical studies evaluation its impact on post- procedural complications including post-ERCP pancreatitis, remains poorly understood. This study aims to address this knowledge gap by evaluating the incidence of post procedural complications in patients using cannabis compared to those non-users. Methods: We conducted a retrospective cohort study in the United States using the TriNetX database to identify adults (≥18 years) undergoing ERCP or EUS and using cannabis. This cohort was matched with patients undergoing ERCP and not using cannabis using 1:1 propensity score matching. The primary outcome was the incidence of post-ERCP pancreatitis within 10 days after ERCP. Secondary outcomes were emergency intubation, aspiration pneumonia, and perforation. With censoring applied, Kaplan-Meier analysis with hazard ratios (HRs) and 95% confidence intervals (CIs) were used to compare time-to-event rates at daily time intervals. Results: A total of 6,564 patients undergoing ERCP and using cannabis were identified and propensity matched with 343,542 non-users undergoing ERCP or EUS, resulting in 6525 matched pairs. Patients treated with cannabis were younger, and had higher rates of cholecystitis, cholelithiasis, and cholangitis (P < 0.001) as compared to controls. After matching, patients undergoing ERCP or EUS and using cannabis had no significant differences in the risk of post-ERCP pancreatitis (1.2% vs 1.5%; adjusted hazard ratio (aHR) = 0.77, 95% CI: 0.53–1.10), without significant differences in aspiration pneumonia (aHR = 1.19, 95% CI: 0.68–2.07), emergency intubations (aHR = 1.16, 95% CI: 0.42–3.19), and gastrointestinal perforations (aHR = 0.86, 95% CI: 0.29–2.55) at 10 days follow-up. Conclusion: Our findings provide real-world evidence that cannabis use in patients undergoing ERCP or EUS does not significantly increase or reduce the risk of post-ERCP pancreatitis compared to non-users. These results suggest that cannabis use may not be an independent risk factor for other post-procedural complications, though further prospective studies are needed to clarify its role in outcomes and potential interactions with patient risk profiles.