Abstract No. 6 Therapeutic Percutaneous Cholangioscopy vs Endoscopic Retrograde Cholangiopancreatography: Reintervention and Complication Rates

Percutaneous cholangioscopy (PCS) and endoscopic retrograde cholangiopancreatography (ERCP) have overlapping therapeutic utility in treating diseases of the biliary tree, but there is poor data comparing the two. This study seeks to compare PCS and ERCP through an assessment of their reintervention and complication rates. The database TriNetX (Cambridge, MA) was used to retrospectively analyze patients who underwent PCS and ERCP in the past decade. Patients from each group were matched based on sex, BMI, and the Charlson Comorbidities Index diseases. All outcomes were measured in the 1-month post-intervention period. 6996 and 266,986 patients were identified as having underwent PCS and ERCP, respectfully; after matching, both groups had 6990 patients. The PCS group was at a higher risk of undergoing biliary reintervention than the ERCP group (45.12% vs 17.85%, p< 0.0001). Post-interventional acute pancreatitis risk (RR=0.66, 95% CI [0.52, 0.83]) and intra/post-interventional bleeding risk (RR=0.75, 95% CI [0.561, 0.998]) were lower with PCS than ERCP. Accidental intra-procedure perforation was not significantly different between the PCS and ERCP groups (RR= 1.33, 95% CI [0.69, 2.54]). Patients who underwent PCS were at a higher risk for peritonitis (RR=1.81, 95% CI [1.36, 2.42]), abscess formation (RR=1.87, 95% CI [1.35, 2.58]), and cholangitis (RR=1.39, 95% CI [1.18, 1.65]) than for ERCP. Percutaneous Cholangioscopy was favorable to Endoscopic Retrograde Cholangiopancreatography for risk of post-intervention acute pancreatitis and bleeding, but also carried a higher risk of peritonitis, abscess formation, and cholangitis. Generally, there were relatively small magnitude differences in PCS and ERCP outcomes and utility for each should be weighed against the individual complexity of each case.