Factors affecting technical success of endoscopic retrograde cholangiopancreatographic outcomes in patients with surgically altered foregut anatomy: a retrospective study.

Introduction: Patients with surgically altered gastrointestinal anatomy undergoing endoscopic retrograde cholangiopancreatography (ERCP) pose challenges due to anatomical distortions. Various patient and endoscopic factors, such as sex and positioning, may impact procedural success. It is unclear how these factors may impact the technical success of ERCP among patients with altered anatomy.

Objective: We aimed to determine the patient and endoscopic factors that were associated with technical success of ERCP.

Methods: We conducted a retrospective single-centre study using data from 2010 to 2020 that included patients with hepaticojejunostomy, Roux-en-Y anastomosis, Billroth-1, or Billroth-2 anatomy at a single tertiary care centre in Toronto, Canada. We extracted data from a database. The primary outcome was technical success of the ERCP, defined as successful navigation to the papilla or surgical anastomosis, selective cannulation and cholangiography or pancreatography. Penalized logistic regression with elastic net regularization was used to identify significant predictors of technical success. Effect size was odds ratio with 95% confidence interval. The model was evaluated using the area under the curve (AUC) metric.

Results: Overall, there were 205 patients included in the analysis. In the multivariate analysis, the most significant contributors to predicting technical success of ERCP were expert endoscopic experience and non-Roux-en Y anatomy. The elastic net model demonstrated moderate predictive performance, with an AUC of 0.656.

Conclusions: The findings emphasize the importance of tailored procedural planning to optimize ERCP success in patients with altered anatomy.