{
  "abstract": "Introduction Post-ERCP Pancreatitis (PEP) is the most common complication of ERCP but can also occur post EUS and fine needle biopsy (EUS-FNB) in isolation. Patients with suspected malignancy may require single session dual EUS-FNB and ERCP, potentially exposing them to a ‘double hit’ risk of PEP.Methods An international, multicentre retrospective review of prospectively maintained databases over a 3 year period (2022-2025). Data was collected for ERCP alone, combined EUS without biopsy and ERCP (EUS/ERCP), and combined EUS with fine needle biopsy and ERCP (EUS - FNB/ERCP) procedures. PEP rates within 7 days of the procedure were examined and potential contributing factors were explored using multivariable logistic regression analysis. The χ2 test and Mann-Whitney U test were used to compare categorical and continuous variables respectively.Results In total, 1966 procedures performed at two tertiary care centres from England and Ireland were included; median age of patients 71 years (IQR 59-79) and 50% were male. 21% (n=419) of the procedures were performed for malignant indications. Procedure types included; ERCP- 82% (n=1609); EUS/ERCP - 14% (n=270); and EUS-FNB/ERCP - 5% (n=94). 63% (n=1255) of ERCPs were index (native ampulla) procedures.Overall PEP rate was 5% (n=100) and it was more common in younger age group (median age [IQR] 68 [48-75] vs 71 [59-79], p=0.004), index ERCP procedures (6.6% vs 2.8%, p=<0.01) and among patients who required more sedation (median midazolam dose 5mg [3-7] vs 4.5mg [3-6], p=0.04, median fentanyl 100 mcg [50-100] vs 75 [50-100], p <0.01). No statistically significant difference in PEP rates was found between sex groups (male - 4.5% vs female - 5.6%, p=0.22), between procedure types (ERCP - 4.6%, EUS/ERCP - 7.0% and EUS-FNB/ERCP - 6.4%, p 0.22) and between malignant and non-malignant indications (7.5% vs 6.2%, p=0.45).On multivariable regression analysis, the factors independently associated with PEP included; younger age (odds ratio 0.98 [confidence interval 0.97-0.99]); index ERCP (2.78 [1.63 – 4.65]); and increasing opiate dose (1.01 [1.00 – 1.02]).Conclusions Single-session EUS-FNB and ERCP does not constitute an additive PEP risk and remains appropriate for simultaneous diagnosis and drainage for malignant indications. Index ERCPs, younger age and increasing sedation requirements significantly increased PEP risk.",
  "authors": [
    {
      "affiliations": [
        "Freeman Hospital, Newcastle-upon-Tyne, United Kingdom"
      ],
      "name": "Eoin Keating"
    },
    {
      "affiliations": [
        "Freeman Hospital, Newcastle-upon-Tyne, United Kingdom"
      ],
      "name": "Umair Kamran"
    },
    {
      "affiliations": [
        "Freeman Hospital, Newcastle-upon-Tyne, United Kingdom"
      ],
      "name": "Bidour Awadelkarim"
    },
    {
      "affiliations": [
        "Mater Misericordiae University Hospital, Dublin, Ireland"
      ],
      "name": "Jan Leyden"
    },
    {
      "affiliations": [
        "Mater Misericordiae University Hospital, Dublin, Ireland"
      ],
      "name": "Gayle Bennett"
    },
    {
      "affiliations": [
        "Mater Misericordiae University Hospital, Dublin, Ireland"
      ],
      "name": "Barry Kelleher"
    },
    {
      "affiliations": [
        "Mater Misericordiae University Hospital, Dublin, Ireland"
      ],
      "name": "Navneet Ramlaul"
    },
    {
      "affiliations": [
        "Mater Misericordiae University Hospital, Dublin, Ireland"
      ],
      "name": "Harvey Martir"
    },
    {
      "affiliations": [
        "Mater Misericordiae University Hospital, Dublin, Ireland"
      ],
      "name": "Stephen Stewart"
    },
    {
      "affiliations": [
        "Freeman Hospital, Newcastle-upon-Tyne, United Kingdom"
      ],
      "name": "S Esmaily"
    },
    {
      "affiliations": [
        "Freeman Hospital, Newcastle-upon-Tyne, United Kingdom"
      ],
      "name": "Richard Charnley"
    },
    {
      "affiliations": [
        "Freeman Hospital, Newcastle-upon-Tyne, United Kingdom"
      ],
      "name": "Padraic McDonagh"
    },
    {
      "affiliations": [
        "Freeman Hospital, Newcastle-upon-Tyne, United Kingdom"
      ],
      "name": "Manu Nayar"
    },
    {
      "affiliations": [
        "Freeman Hospital, Newcastle-upon-Tyne, United Kingdom"
      ],
      "name": "John Leeds"
    },
    {
      "affiliations": [
        "Freeman Hospital, Newcastle-upon-Tyne, United Kingdom"
      ],
      "name": "Kofi Oppong"
    }
  ],
  "title": "FP37 Does single session EUS-FNB plus ERCP increase the risk of post-ERCP pancreatitis?",
  "uid": "deb22407-fe4e-50d6-a79f-faf65fdede3a"
}