Early Endoscopic Retrograde Cholangiopancreatography is Associated With Improved Health Care Resource Utilization in Acute Biliary Pancreatitis Without Cholangitis

Background: The optimal timing for endoscopic retrograde cholangiopancreatography (ERCP) in managing uncomplicated acute biliary pancreatitis (ABP) remains unclear. This population-based study assessed the impact of ERCP timing on outcomes in hospitalized ABP patients without cholangitis or sepsis. Methods: Using the Nationwide Readmission Database (2016 to 2020), patients with ABP who underwent ERCP were identified, excluding those with cholangitis/sepsis. ERCP timing was categorized as early (0 to 1 d) or delayed (2 to 7 d). Outcomes, including mortality, 30-day readmissions, and health care resource utilization were analyzed using multivariable logistic regression. Results: Among 54,250 noninfectious ABP patients, 42.13% underwent ERCP. There was no significant difference in in-hospital mortality between early and delayed ERCP groups (0.26% vs. 0.24%, P =0.73). However, 30-day readmission rates rose with each day of delay in the delayed ERCP group ( P <0.001) and were higher overall (8.26% vs. 7.51%, P =0.03). Delayed ERCP was associated with increased 30-day readmissions (OR: 1.11, 95% CI: 1.00-1.22); using alternate categorical thresholds, ERCP on day 4 or later was also linked to higher odds of readmission (OR: 1.35, 95% CI: 1.18-1.54). Early ERCP was associated with reduced mean length of stay by 1.51 days (95% CI: −1.51 to −1.50; P <0.001) and hospital costs by $1536.45 (95% CI: −$1545.37 to −$1527.52; P <0.001) after multivariable adjustment. Compared with day 4 or later, ERCP on days 2 to 3 further reduced stay by 2.42 days and costs by $3756.95 (both P <0.001). Conclusion: Delayed ERCP was associated with increased 30-day readmission rates and greater health care resource utilization and ERCP performed within 4 days may improve hospital quality metrics in patients with noninfectious acute biliary pancreatitis.