Patients with cystic fibrosis do not have an increased risk of adverse events after endoscopic retrograde cholangiopancreatography: a propensity-matched analysis

Abstract

Background Cystic fibrosis (CF) is a common life-limiting genetic disease often associated with hepatobiliary complications. Endoscopic retrograde cholangiopancreatography (ERCP), though valuable, carries procedural risks. We assessed the safety of ERCP in CF patients using real-world data.

Methods A retrospective cohort study using the TriNetX database (2010-2024) identified adults (≥18 years) with CF who underwent ERCP. Propensity-score matching adjusted for confounders, including age, sex, race, and hospitalization history. The primary outcome was post-ERCP pancreatitis (PEP); secondary outcomes included bleeding and infection. Subgroup analysis evaluated outcomes in patients with choledocholithiasis.

Results Among 534 matched CF patients (mean age 44.6 years; 48.3% female), rates of PEP (8.3% vs. 4.9%, adjusted odds ratio [aOR] 1.76, 95% confidence interval [CI] 0.937-3.315; P=0.075), bleeding (3.1% vs. 2.1%, aOR 1.52, 95%CI 0.674-3.409; P=0.31), and infection (3.7% vs. 2.4%, aOR 1.55, 95%CI 0.638-3.785; P=0.33) were not significantly different compared to non-CF controls. Subgroup analysis of choledocholithiasis patients similarly showed no significant differences.

Conclusions ERCP in CF patients demonstrated comparable adverse event rates to non-CF controls. These findings support the procedural safety of ERCP in this population, though further prospective studies are needed to validate these results and clarify risk by indication.

Keywords Cystic fibrosis, endoscopic retrograde cholangiopancreatography (ERCP), post-ERC pancreatitis, hepatobiliary complications, ERCP complications

Ann Gastroenterol 2025; 38 (4): 446-452