Annals of Gastroenterology

Brown bowel syndrome: a systematic review

Rena Cao, Jason Diab, Michael C. Grimm, Christophe R. Berney — Fri, 16 May 2025 14:43:34 +0300

Brown bowel syndrome (BBS) is a rare disorder characterized by brown pigmentation of the intestinal wall, thought to be a consequence of lipofuscin accumulation. Celiac disease and vitamin E deficiency have been postulated to be risk factors. We systematically searched PubMed, Embase, Web of Science and Cochrane to identify all case reports and abstracts reporting clinical information on patients with a confirmed diagnosis of BBS. Forty-two studies met our inclusion criteria, including 63 patients with confirmed BBS. The most common symptoms of BBS were diarrhea (50.8%) and malnutrition (50.8%), followed by abdominal pain (39.7%) and vomiting (22.2%). BBS patients with celiac disease who presented with similar symptoms to non-celiac patients were significantly less likely to be hypoalbuminemic (15.4 vs. 45.5%) and showed a non-significant trend towards a higher mortality rate (36.4% vs. 15.4%). Nineteen (31.7%) BBS patients were also vitamin E deficient. The clinical presentation and outcomes in BBS patients with vitamin E deficiency and celiac disease were similar to those without vitamin E deficiency and celiac disease. Further studies are warranted to better define the diagnostic-therapeutic approach to patients with BBS.

Keywords Intestinal lipofuscinosis, ceroidosis, vitamin E deficiency

Ann Gastroenterol 2025; 38 (3): 237-246

Pancreatic ascites: update on diagnosis and management

Fri, 16 May 2025 14:48:39 +0300

Pancreatic ascites is a rare condition characterized by the accumulation of high-amylase ascitic fluid in the peritoneal cavity. This condition is often associated with chronic pancreatitis, pancreatic trauma, or pseudocyst rupture. Because of its rarity and ill-defined clinical presentation, pancreatic ascites is often a diagnostic and therapeutic challenge in clinical practice. The current diagnostic criteria include an amylase level >1000 mg/dL, a protein level >3 g/dL, and a serum ascites albumin gradient <1.1 g/dL. The clinical features vary, but may include progressive abdominal distension, diffuse abdominal pain, weight loss and peritonitis. The management of pancreatic ascites remains controversial, and there is no consensus regarding the optimal approach. Conservative medical management, which includes nutritional support, pain control, therapeutic paracentesis and the use of somatostatin analogs, has been associated with a high failure rate and significant morbidity. Interventional therapies, such as surgery and endoscopic transpapillary stenting, have shown more promising outcomes. However, the choice between these methods is still debated, with some advocating for endoscopic approaches, because of their minimally invasive nature and reduced morbidity compared with surgical options. Endoscopic approaches remain underutilized in practice, probably because of the need for repeated interventions, the potential risks associated with endoscopic retrograde cholangiopancreatography, or a lack of skilled personnel. Although they show significant perioperative morbidity and mortality, surgical options provide definitive resolution of pancreatic ascites. Herein, we provide an updated review of pancreatic ascites, highlighting advances in diagnostic techniques and therapeutic approaches, and summarizing insights from recent clinical cases and retrospective studies.

Keywords Pancreatic ascites, chronic pancreatitis, duct disruption, pseudocyst, endoscopic stenting

Ann Gastroenterol 2025; 38 (3): 247-254

Gastric peroral endoscopic myotomy improves chronic diarrhea in patients with refractory gastroparesis

Fri, 16 May 2025 14:53:27 +0300

Background The main symptoms of gastroparesis are early satiety, nausea, vomiting and bloating. In our daily practice, we observed some patients presenting with concomitant chronic alteration of stool frequency. The present study describes retrospectively the impact of gastric peroral endoscopic myotomy (G-POEM) on patients presenting refractory gastroparesis and concomitant chronic diarrhea or constipation.

Methods This retrospective study analyzed the clinical course of patients with refractory gastroparesis and concomitant chronic alteration of stool frequency who were consecutively treated with G-POEM between January 2019 and October 2023 in a tertiary referral center.

Results Of 107 patients with refractory gastroparesis treated by G-POEM, 11 (10.3%) patients (mean age 60.4±16.2 years, 64% female) had altered bowel frequency for >6 months without any other underlying disease (diarrhea n=10; constipation n=1). Scintigraphy confirmed delayed gastric emptying in 10/11 (91%) of cases. G-POEM was technically feasible in all patients without adverse events during or after endoscopic treatment. The median follow-up period was 170 days (interquartile range [IQR] 33-1002). In 9/11 (81%) patients, G-POEM achieved clinical success with a mean gastroparesis cardinal symptom index (GCSI) of 3.1 (interquartile range [IQR] 2.7-3.4) before, and 0.9 (IQR 0.7-1.7) after the endoscopic treatment. Normalization of bowel movements after G-POEM was observed in 9/11 (81%) of patients. Two patients had partial symptom improvement (loose bowels, but normal frequency), 1 of them without improvement of GCSI and persistent delayed emptying on scintigraphy.

Conclusion Gastroparesis may present with concomitant chronic diarrhea that improves after endoscopic treatment by G-POEM.

Keywords Gastroparesis, gastric peroral endoscopic myotomy, diarrhea, gastroparesis cardinal symptom index

Ann Gastroenterol 2025; 38 (3): 255-261

Helicobacter pylori infection negatively affects response of gastric cancer to immunotherapy

Fri, 16 May 2025 15:00:28 +0300

Background Helicobacter pylori (H. pylori) is a known risk factor for gastric cancer, possibly via the PD-1/L1 pathway, and this infection may reduce the efficacy of immune checkpoint inhibitors (ICIs). This study explored the effects of H. pylori infection status on survival outcomes in patients with gastric cancer.

Methods This single-center, retrospective study included patients with gastric adenocarcinoma between June 1985 and August 2022. Patients with different histological subtypes were excluded. Primary variables of interest included H. pylori infection status and treatment with ICIs. Other clinical information included demographics, cancer histology, the presence of other cancers, and vital status.

Results A total of 2930 patients were included, of whom 206 (7.0%) received ICIs, 196 (6.7%) had prior H. pylori infection, and 1037 (35.4%) had a diffuse subtype. Diffuse cancer subtypes were associated with better survival (P<0.05) at 3 and 5 years compared to intestinal-type adenocarcinomas. Diffuse cancers demonstrated better survival outcomes than intestinal cancers at 10 years, but only among H. pylori-positive patients (P=0.013). H. pylori positivity was associated with worse survival at 3 years (P=0.041) among patients taking ICIs, but not in those not receiving ICIs (P=0.325).

Conclusions These findings suggest H. pylori infection may be an obstacle to successful immunotherapy, and may interact with cancer subtypes to differentially impact survival. Future studies are needed to validate the potential prognostic value of H. pylori positivity in gastric cancer.

Keywords Helicobacter pylori, immunotherapy, gastric cancer

Ann Gastroenterol 2025; 38 (3): 262-269

Beyond biopsy: evaluating noninvasive techniques to diagnose celiac disease in adults

Suzanne Cauchi, Abigail Pace, Martina Sciberras, Pierre Ellul — Fri, 16 May 2025 15:05:38 +0300

Background Duodenal biopsies are standard for diagnosing celiac disease (CD), but a biopsy-free approach has gained attention in the past decade. Evidence suggests that immunoglobulin A antitissue transglutaminase (IgA tTg) antibody levels ≥10 times the upper limit of normal (ULN) may reduce the need for histology. This study aimed to assess whether IgA tTg antibody titers ≥10 × ULN correlate with the histological diagnosis in adults.

Methods The retrospective study was conducted at Mater Dei Hospital, Malta, analyzing adult patients who underwent upper gastrointestinal endoscopy with duodenal biopsies between 2012 and 2024. Data on demographics, symptoms, risk factors, serology and histological results were collected. Patients who had positive serology but initial negative biopsies and underwent repeat biopsies were also reviewed.

Results Of 114 patients (78.1% female, mean age 41.0 years), 97.4% tested positive for IgA tTg antibodies and 93.8% for endomysial antibodies (EMA). CD was histologically confirmed in 70.2%, with females more frequently diagnosed than males (75.3% vs. 52%, P=0.025). CDrelated symptoms were reported by 79.8%, while 20.2% were asymptomatic. Levels of tTg ≥10 × ULN were found in 41.2% patients, and this cutoff had a sensitivity of 58.8%, specificity of 100%, positive predictive value of 100% and negative predictive value of 50.7% for CD (P<0.001).

Conclusion This study supports a biopsy-free approach for diagnosing CD when IgA tTg levels are ≥10 x ULN, especially with EMA positivity and typical clinical presentation.

Keywords Celiac disease, biopsy-free, noninvasive, celiac serology

Ann Gastroenterol 2025; 38 (3): 270-275

Angiotensin-converting enzyme inhibitor-induced bowel angioedema: clinical features, diagnostic challenges, and recovery predictors from survival analysis: a systematic review of current reported cases

Fri, 16 May 2025 15:16:16 +0300

Background Angiotensin-converting enzyme inhibitor-induced bowel angioedema (ACEi-IAE) is a rare and frequently under-recognized condition. Its nonspecific gastrointestinal symptoms could lead to missed diagnoses, unnecessary procedures and inappropriate treatments. Given the scarcity of studies, we conducted a systematic review to summarize the clinical characteristics of ACEi-IAE, the diagnostic approach and factors predicting delayed recovery.

Methods Electronic databases, including MEDLINE, OVID and EMBASE, were used to identified eligible studies from inception to November 2024. Eligible cases were required to have a clear diagnosis of ACEi-IAE. Kaplan-Meier and multivariate Cox regression analyses were used to identify factors associated with delayed recovery time.

Results Our systematic review included 81 eligible studies, comprising 117 ACEi-IAE cases with a mean age of 50 years, of which 83% were female. Patients were mainly African Americans (50%) taking lisinopril (71%). All patients (100%) presented with abdominal pain and other non-specific features. The median recovery time was 48 h after discontinuing ACEi. Patients who had been taking lisinopril for a longer than average period (25.9 months) had a statistically significantly lower hazard ratio for recovery (adjusted hazard ratio [aHR] 0.39, 95% confidence interval [CI] 0.19-0.81; P=0.012), as did patients who had radiographic evidence of jejunal edema (aHR 0.29, 95%CI 0.11-0.74; P=0.010). Diagnostic criteria were proposed and summarized based on the findings.

Conclusions Clinicians should be aware of ACEi-induced bowel angioedema, particularly in ACEi users with non-specific abdominal pain. Implementation of our proposed diagnostic criteria is recommended to prevent unnecessary investigation and inappropriate treatment.

Keywords Angiotensin-converting enzyme inhibitors, bowel angioedema, epidemiology

Ann Gastroenterol 2025; 38 (3): 276-283

Antidepressants in irritable bowel syndrome: a systematic review and meta-analysis of randomized controlled trials

Fri, 16 May 2025 15:20:34 +0300

Background Irritable bowel syndrome (IBS) treatment relies on a low level of evidence. In this systematic review with meta-analysis of randomized, double-blind, placebo-controlled trials we assessed the efficacy of antidepressants in IBS.

Methods This study followed the PRISMA guidelines and was registered in the PROSPERO database (CRD42024502427). PubMed, EMBASE and the Cochrane Library were searched from inception to January 2024. Only randomized, double-blind, placebo-controlled trials were included. Quality of evidence was assessed using the Cochrane tool (RoB 2). A random-effects model was used. Heterogeneity was evaluated by the I2 statistic and publication bias by funnel plots and the Egger test.

Results The search strategy identified 1340 studies, of which 20 were included in the systematic review and 16 in the meta-analysis, totaling 1428 patients. The meta-analysis unveiled the efficacy of antidepressants in patients with IBS in overall symptom improvement (odds ratio [OR] 3.02; 95% confidence interval [CI] 2.16-4.2). Subgroup analysis revealed similar results regarding the efficacy of tricyclic antidepressants (OR 3.39, 95%CI 2.24-5.12); of selective serotonin reuptake inhibitors (OR 2.39, 95%CI 1.14-5.01); in patients refractory to first-line measures (OR 2.96, 95%CI 1.67-5.25); in patients without known comorbid psychological conditions (OR 2.92, 95%CI 1.6-5.31); and in the improvement in abdominal pain (OR 3.27, 95%CI 1.63-6.53), and bloating (OR 2.4, 95%CI 1.11-5.22). Publication bias was detected, and potential sources were identified. Sub-analysis without these sources of bias revealed similar results.

Conclusions Antidepressants demonstrate efficacy in IBS. These medications can be beneficial to patients resistant to initial treatments and those lacking psychopathological symptoms.

Keywords Irritable bowel syndrome, antidepressants, tricyclic antidepressants, selective serotonin reuptake inhibitors, meta-analysis

Ann Gastroenterol 2025; 38 (3): 284-293

Racial disparity in inflammatory bowel disease-related complications: a nationwide cohort study

Bobak Moazzami, Zohyra E. Zabala, Raguraj Chandradevan, Humberto Sifuentes — Sun, 18 May 2025 13:03:56 +0300

Background Racial disparities in inflammatory bowel disease (IBD)-related complications are increasingly recognized, yet nationwide data remain limited. This study examined racial differences in IBD-related complications across diverse patient populations.

Methods We analyzed data from the Nationwide Inpatient Sample 2016-2021, on over 1.7 million weighted hospitalizations for IBD. Adults with Crohn’s disease (CD) or ulcerative colitis (UC) were identified using ICD-10 codes. Key outcomes included anal abscess, intestinal obstruction, rectal bleeding and anal fissure/fistula, were compared across racial groups. Multivariate logistic regression was used to estimate the odds of complications, adjusting for age, sex, insurance, comorbidities, and hospital factors.

Results Compared to White patients, Black and Hispanic patients with CD had higher rates of anal abscesses (2.8% and 2.57% vs. 1.25%) and rectal bleeding (2.85% and 2.51% vs. 1.79%). Multivariate logistic regression showed that Black and Asian patients had higher odds of developing anal abscess compared to White patients (adjusted OR [aOR] 1.41, 95% confidence interval [CI] 1.38–1.45] and aOR 1.19, 95%CI 1.13-1.29, respectively). In UC, Black (aOR 1.33, 95%CI 1.29-1.37), Hispanic (aOR 1.23, 95%CI 1.21-1.27), and Asian patients (aOR 1.12, 95%CI 1.04-1.20) had higher odds of rectal bleeding, while the odds of intestinal obstruction were lower in Black (aOR 0.74, 95%CI 0.67-0.82), compared to White patients.

Conclusions Racial disparities exist in complications associated with IBD. Black and Hispanic patients had higher odds of perianal complications, while White patients had more intestinal obstruction. These findings emphasize the need for earlier intervention and improved access to advanced therapies in diverse populations.

Keywords Disparities, race, inflammatory bowel disease, Crohn’s disease, ulcerative colitis

Ann Gastroenterol 2025; 38 (3): 294-305

Induction with upadacitinib in Crohn’s disease: real-world experience from an early-access program in Greece

Sun, 18 May 2025 13:07:51 +0300

Background Upadacitinib is a selective Janus kinase-1 inhibitor, approved for the management of Crohn’s disease (CD) by the United States Food & Drug Administration. In Greece, upadacitinib was initially available through an early-access program. Our goal was to describe the real practice experience.

Methods This was a multicenter retrospective cohort study of patients with moderate-to-severe CD. The primary endpoint was clinical response, defined as a reduction ≥3 in the Harvey-Bradshaw index. Secondary endpoints included biochemical improvement. Outcomes were assessed at 4, 8 and 12 weeks.

Results A total of 24 CD patients received upadacitinib and were included in the analysis. Their mean age was 42.2 years (range 24-63). Eleven patients (45.8%) had ileocolonic CD and 5 (20.8%) CD colitis. Fourteen patients had active extraintestinal manifestations. The majority of patients (19/24) had ≥3 failed biologics. All of them had failed treatment with anti-tumor necrosis factor and 19 (79%) with ustekinumab. At 12 weeks, nearly all patients achieved a clinical response (85%). Of 13 patients with C-reactive protein >5 mg/L at baseline, 11 (84.6%) achieved normalization by week 8. Adverse events occurred in 3 patients (14.2%).

Conclusion In a small cohort of resistant CD patients, the short-term clinical efficacy of upadacitinib was high.

Keywords Upadacitinib, Crohn’s disease, Greece

Ann Gastroenterol 2025; 38 (3): 306-310

Trends in admissions and outcomes of hospitalizations related to Clostridioides difficile infection: a nationwide analysis from 2005-2020

Sheza Malik, Ese Uwagbale, Olayemi A. Adeniran, Arshia Sethi, Raseen Tariq — Sun, 18 May 2025 13:12:14 +0300

Background Clostridioides difficile infection (CDI) is one of the major causes of healthcare-associated infectious colitis. This study analyzed trends in CDI-related hospitalizations in the United States (US) from 2005-2020, focusing on changes in patient demographics, disease severity and outcomes.

Methods Our study was a retrospective observational analysis using the National Inpatient Sample (NIS) from 2005-2020, focusing on US adults with primary and secondary CDI diagnoses. We performed statistical analysis using SAS 9.4 and joinpoint regression models to identify trends and changes in CDI prevalence and severity, as well as patient outcomes, over the 15-year period.

Results The study analyzed 939,282 patients, 30.2% of whom had primary and 69.8% secondary CDI diagnoses. Over the study period, there was a decline in CDI prevalence from 94.8 to 78.1 per 10,000 hospitalizations. This trend showed an increase in prevalence among younger adults (18-34 years) but a notable decrease in older adults (≥85 years). Sex-related and racial/ethnic disparities were also evident. The incidence of megacolon surged from 12.9 per 10,000 hospitalizations in 2005 to 69.8 per 10,000 in 2020, a more than fivefold increase. In contrast, in-hospital mortality from CDI significantly decreased, from 1028 deaths per 10,000 CDI diagnoses in 2005 to 687 per 10,000 in 2020, a 33.1% reduction.

Conclusions Our study indicated improved management and prevention of CDI, as evidenced by the overall decrease in prevalence and mortality. However, the increase in severity markers and the variable trends across different demographic groups highlight the need for ongoing vigilance and targeted interventions.

Keywords Clostridioides difficile, epidemiology, hospitalization, mortality, severity

Ann Gastroenterol 2025; 38 (3): 311-318

Impact of neutrophil-to-lymphocyte ratio on survival outcomes among cirrhotic and non-cirrhotic patients with advanced hepatocellular carcinoma under atezolizumab–bevacizumab combination therapy

Sun, 18 May 2025 13:20:05 +0300

Background The efficacy of atezolizumab–bevacizumab in patients with hepatocellular carcinoma (HCC) has not been studied separately in cirrhotic and non-cirrhotic patients. Our aim was to evaluate the efficacy of atezolizumab–bevacizumab in these patients, in relation to baseline values of the neutrophil-to-lymphocyte ratio (NLR).

Methods We divided 57 atezolizumab–bevacizumab-treated HCC patients according to baseline NLR (>3: NLR-H, ≤3: NLR-L) and studied overall survival (OS) and progression-free survival (PFS) in 4 groups: group A, non-cirrhotic/NLR-L; group B, non-cirrhotic/NLR-H; group C, cirrhotic/NLR-L; and group D, cirrhotic/NLR-H.

Results The 4 groups were comparable except for etiology, ALBI grade, macrovascular invasion, Barcelona Clinic Liver Cancer stage and prior therapy. Median OS and PFS were 30, 10, 12 and 5 months, and 14, 4, 8 and 2 months, for groups A, B, C, D, respectively (P<0.001). By Cox regression, cirrhotic/NLR-H patients showed significantly worse OS and PFS. Cirrhotic/NLR-L patients had better OS (12 vs. 5 months, P=0.002) and PFS (8 vs. 2 months, P=0.028) compared to cirrhotic/NLR-H. NLR was significantly correlated with OS (P=0.015). Non-cirrhotic/NLR-L patients had better OS (30 vs. 10 months, P=0.006) and PFS (15 vs. 4 months, P=0.01) compared to non-cirrhotic/NLR-H patients. Prior therapy was significantly correlated with better OS (30 vs. 8 months, P<0.001) and PFS (24 vs. 4 months, P<0.001) in non-cirrhotic patients.

Conclusions Cirrhotic/NLR-H HCC patients presented the worst survival. NLR is an independent risk factor for worse survival in cirrhotic patients. Prior therapy is the only factor significantly correlated with OS and PFS in non-cirrhotic patients.

Keywords Hepatocellular carcinoma, immunotherapy, cirrhosis, neutrophil-to-lymphocyte ratio

Ann Gastroenterol 2025; 38 (3): 319-327

Incidence of ileus and associated factors in patients with acute pancreatitis: a nationwide analysis

Sun, 18 May 2025 13:24:46 +0300

Background Ileus is a well-known complication of acute pancreatitis (AP). There are limited data on the factors associated with ileus, as well as its impact on AP patients. We aimed to investigate the incidence and clinical predictors of ileus in hospitalized AP patients.

Methods We queried the 2016-2019 National Inpatient Sample (NIS) database using the International Classification of Diseases (ICD)-10 codes. Adult patients diagnosed with AP (ICD-10 K85) were included, excluding those with chronic pancreatitis. Demographics, comorbidities, complications and interventions were stratified by the presence of ileus. Multivariate analysis identified factors associated with ileus, adjusting for patient and hospital characteristics, comorbidities, and pancreatitis complications.

Results Among 1,386,390 AP patients, 50,170 (3.6%) developed ileus. Female sex was associated with a lower risk (adjusted odds ratio [aOR] 0.56, 95% confidence interval [CI] 0.53-0.58; P<0.001). Hispanic patients had the lowest risk (aOR 0.82, 95%CI 0.76-0.88), while older age groups had a higher risk. Pseudocysts (P<0.001), sepsis (P<0.001) and portal vein thrombosis (P<0.001) were significant predictors. Pancreatic drainage was associated with ileus (P=0.007), but endoscopic retrograde cholangiopancreatography was not. Patients with ileus had greater mortality (P<0.001), longer hospital stays (+4.9 days, P<0.001), and higher costs ($67,855.91, P<0.001).

Conclusions This study highlights age, sex and racial disparities in the development of ileus in patients with AP. It also reveals a significant association of ileus with pseudocysts, portal vein thrombosis, and pancreatic drainage. Early recognition and timely enteral feeding are crucial to prevent disease progression and improve outcomes.

Keywords Ileus, pancreatitis, national inpatient sample, factors, incidence

Ann Gastroenterol 2025; 38 (3): 328-336

Admissions for acute biliary pancreatitis without necrosis and infection complicated by severe sepsis and septic shock: a national study

Renuka Verma, Kamleshun Ramphul, Hemamalini Sakthivel — Sun, 18 May 2025 13:28:45 +0300

Background Severe sepsis with septic shock (SSWSS) is a potential and severe complication that can arise among patients hospitalized for acute biliary pancreatitis.

Methods We queried the 2018-2021 National Inpatient Sample for adults with a primary diagnosis code of acute biliary pancreatitis without necrosis or infection. Baseline characteristics of the patients were studied and multivariate regression models were used to appraise the roles of different factors for events of SSWSS.

Results We evaluated 136,140 adults who had acute biliary pancreatitis without necrosis or infection on admission; their median age was 57.0 years, and the majority were female (60.6%). Of these, 435 patients developed SSWSS. Higher odds were seen in cases with coexisting chronic kidney disease (P<0.001), liver cirrhosis (P<0.001), and human immunodeficiency virus infection (P<0.001). Races other than White/Black/Hispanics had higher odds (P<0.001) than Whites. Females were less likely to report SSWSS (P<0.001) than males. Moreover, patients from the
26th-50th median household quartiles had lower odds of SSWSS than those in the 0-25th quartiles. Medium (P<0.001) and large (P<0.001) hospitals reported more cases than small hospitals. Admissions in the southern areas of the United States also exhibited higher odds (P=0.026), than Northeast regions. Lower odds were noted in smokers (P<0.001) and cases with dyslipidemia (P=0.048). SSWSS led to higher mortality rates (65.5% vs. 0.4%).

Conclusions In our nationwide analysis, we found that episodes of SSWSS among patients with acute biliary pancreatitis were influenced by several factors. SSWSS patients also had higher mortality.

Keywords Acute biliary pancreatitis, severe sepsis, critical care, United States of America

Ann Gastroenterol 2025; 38 (3): 337-344

Impact of atrial fibrillation on in-hospital outcomes following endoscopic retrograde cholangiopancreatography: a propensity score-matched analysis of the National Inpatient Sample (2016-2020)

Sun, 18 May 2025 13:33:41 +0300

Background Endoscopic retrograde cholangiopancreatography (ERCP) is a critical tool in managing hepatobiliary and pancreatic diseases. Atrial fibrillation (AF) has been associated with greater morbidity in patients undergoing ERCP. This study compared in-hospital ERCP outcomes in patients with and without AF.

Methods This retrospective cohort study utilized data from the National Inpatient Sample (2016-2020). Patients who underwent ERCP during hospitalization were included. Patients with AF were matched 1:1 to those without AF, based on demographic and clinical variables. The primary outcome was all-cause in-hospital mortality. Secondary outcomes included procedurerelated and non-procedure-related complications, hospitalization cost and length of stay.

Results The final matched sample consisted of 29,942 patients, with 14,971 in each group (AF and non-AF). Patients with AF demonstrated significantly higher in-hospital mortality compared to those without AF (3.6% vs. 1.9%; odds ratio [OR] 1.87, 95% confidence interval [CI] 1.62-2.17). The AF group had a significantly longer median length of stay (8.1 vs. 6.4 days; β 1.7; 95%CI 1.5-1.8) and incurred higher hospitalization costs ($111,000 vs. $87,255; β $23,745; 95%CI $20,783-26,708). In terms of complications, patients with AF had significantly higher rates of acute kidney injury (OR 1.33, 95%CI 1.27-1.40) and sepsis (OR 1.38, 95%CI 1.30-1.48). However, the rates of procedure-specific complications, including biliary perforation, post-ERCP pancreatitis and post-ERCP cholangitis, were similar between the 2 groups.

Conclusion Patients with AF undergoing ERCP have higher in-hospital mortality, longer stays, greater costs, and higher rates of acute kidney injury and sepsis, although procedure-specific complication rates remain unaffected.

Keywords Endoscopic retrograde cholangiopancreatography, atrial fibrillation, mortality, in-hospital outcome, national inpatient sample

Ann Gastroenterol 2025; 38 (3): 345-352