Post written by Anna Tavakkoli, MD, from the University of Texas Southwestern, Dallas, Texas, USA.

Endoscopic retrograde cholangiopancreatography (ERCP) is the primary therapeutic procedure for a number of pancreaticobiliary diseases. The most common adverse event associated with ERCP is post-ERCP pancreatitis (PEP). Studies estimate that PEP can occur in 10% to 15% of patients, and more than 10% of outpatient ERCPs are admitted to the hospital after their procedure. There are very strong clinical trial data on the incidence and risk factors associated with PEP but a lack of real-world data looking at the incidence of PEP among all patients in the U.S. healthcare system.

In addition, for years, PEP has been estimated to cost the United States almost $200 million annually, but this figure had not been validated with real-world data. In our study, we wanted to report on the incidence and cost of PEP using administrative datasets to directly assess these questions. 

Traditionally, ERCP and its associated adverse events have been studied in well-designed randomized controlled trials or mainly single-center retrospective studies. These studies have laid an important foundation on the incidence of PEP but lacked a broad view of the ERCP landscape in the United States and, importantly, the cost associated with PEP. This study was vital to understanding what is occurring around ERCP outside highly controlled clinical trials or single high-volume academic centers. 

Our study found that PEP occurred in 5.7% of ERCPs in Merative MarketScan commercial claims data from 2019 to 2021, with a higher risk of PEP among younger patients and those with a higher comorbidity burden. Thirty-day direct costs were higher among patients who experienced PEP versus those who did not (difference, $8483). We estimated that the population-level cost of PEP is between $85 million and $241 million annually depending on the number of ERCPs performed yearly.

In our study, using a nationally representative cohort, we found that PEP occurs in about 5% to 6% of individuals, but it is very costly. We believe that performing more studies using real-world claims data would be important to understand the national ERCP landscape and to create interventions to improve ERCP outcomes and costs.

Probability of post-ERCP pancreatitis by age with 95% CIs.

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