Title

Safety of Glucagon Use During Endoscopic Retrograde Cholangiopancreatography: A Retrospective Multicentric Study

Abstract

Introduction- Injectable glucagon inhibits gastrointestinal (GI) and duodenal motility by relaxing smooth muscles, decreasing the frequency and amplitude of phasic activity of the sphincter of Oddi. This enables endoscopists to enhance biliary cannulation and extract small bile duct stone. Additionally, glucagon can potentially worsen underlying hyperglycemia and hyperkalemia especially in patients with diabetes. It is unclear if glucagon impacts the adverse events of Endoscopic Retrograde Cholangiopancreatography (ERCP) such as rates of GI bleeding, GI perforation, post-ERCP pancreatitis (PEP) and in patient hospitalizations.

Methods We used TriNetX, a federated cloud-based network comprising of 92 healthcare organizations (HCOs) across the US. All adult patients who underwent ERCP with utilization of glucagon (ERCP w glucagon group) were compared with patients without use of glucagon (ERCP wo glucagon group). The primary outcomes were rates of rates of GI bleeding, GI perforation, post-ERCP pancreatitis (PEP), inpatient hospitalizations and 30- day overall mortality. The clinical outcomes were measured after 1:1 propensity matching of the groups based on the baseline demographics and comorbidities.

Results A total of 9,008 patients were included in ERCP w glucagon group compared to 256,597 in ERCP wo glucagon group. Comorbidites of these patients at presentation, imaging, medications and clinical outcomes are noted in Table 1. Mean age at presentation was 67.7 years (SD- 11.1), with female predominance (54.9%). ERCP w glucagon group patients had higher rates of utilization of opioid agents and indomethacin. After matching, ERCP w glucagon patient had lower rates of GI bleeding (risk ratio [RR]- 0.68 (CI- 0.52 – 0.86)), PEP (RR- 0.64 (CI- 0.58 – 0.71), inpatient hospitalization (RR- 0.34 (CI- 0.32 – 0.36)) and overall mortality (RR- 0.81 (CI- 0.66 – 0.99)). The rates of GI perforation (RR- 0.64 (CI- 0.34 – 1.19)), hyperkalemia (RR- 0.83 (CI- 0.64 – 1.09)) and hyperglycemia (RR- 0.65 (CI- 0.41 – 1.03)) did not differ between two groups.

Discussio- Injectable glucagon during ERCP procedure appears safe with lower rates of GI bleeding, PEP, inpatient hospitalization and overall mortality. Rates of hyperkalemia and hyperglycemia did not different between two groups. This was noted after matching for diabetes, indomethacin use, obesity and chronic kidney disease. Large prospective studies are needed to confirm these findings.

Document Type

Article

Publication Date

10-2021

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