Outcomes of Endoscopic Retrograde Cholangiopancreatography in Patients with Underlying Mental Health Disorders
Date
2024-10-15
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Abstract
Depression and anxiety are significant contributors to the global health burden. In Canada, the lifetime prevalences of depression and anxiety among adults are around 11% and 9%, respectively. These mental health disorders (MHDs) increase post-operative adverse events (AEs), worsen outcomes, and negatively impact healthcare correlates. In gastrointestinal endoscopy settings, pre-procedural anxiety reduces patient satisfaction and increases pain sensitivity and requirements for sedatives. Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard for managing certain pancreaticobiliary conditions. However, it is technically challenging and has the highest rates of AEs and unplanned hospital encounters (UHEs) among endoscopic procedures. There is a knowledge gap regarding the impact of MHDs on ERCP-related outcomes and patient-reported tolerability with conscious sedation. This thesis presents results from two studies seeking to examine the associations between pre-existing MHDs in adult patients undergoing ERCP and: 1) UHEs within 30 days of the procedure, including unplanned emergency department visits and/or admissions for somatic symptoms only without a clear explanatory diagnosis or AE (Study 1), 2) AEs within 30 days of the procedure (Study 1), and 3) patient-reported peri- and post-procedural tolerability (Study 2). Secondary analyses of multi-centre data were conducted using logistic regression while accounting for pertinent covariates. Study 1 found no significant associations between pre-existing MHDs and UHEs or AEs in 6,648 patients undergoing ERCP within 30 days, including visits or admissions for somatic symptoms alone. Conversely, Study 2 demonstrated a significant association between MHDs and poorer patient-reported tolerability of ERCP under conscious sedation. Among 3,714 patients, significantly more participants with MHDs reported increased intra-procedural awareness and discomfort, along with greater post-procedural abdominal pain, nausea, and distension. Using these data, clinicians performing ERCP can provide accurate information regarding MHDs and ERCP-related outcomes. Additionally, increased awareness of the reduced tolerability and worse patient-reported experience measures of ERCP under conscious sedation in patients with depression and/or anxiety can help endoscopists decrease potential patient morbidity and enhance satisfaction. Further study is needed to determine potential associations between more granular MHD-related exposures and post-ERCP outcomes.
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Keywords
Depression, Anxiety, Mental health disorder, Endoscopic retrograde cholangiopancreatography, Adverse events, Unplanned hospital encounter, Patient-reported experience measure
Citation
Tepox Padron, A. (2024). Outcomes of endoscopic retrograde cholangiopancreatography in patients with underlying mental health disorders (Master's thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.