Outcomes of Endoscopic Retrograde Cholangiopancreatography in Patients with Underlying Mental Health Disorders

Tepox Padron, Alejandra

Outcomes of Endoscopic Retrograde Cholangiopancreatography in Patients with Underlying Mental Health Disorders

dc.contributor.advisor	Forbes, Nauzer
dc.contributor.author	Tepox Padron, Alejandra
dc.contributor.committeemember	El-Gabalawy, Renée
dc.contributor.committeemember	Hilsden, Robert Jay
dc.date.accessioned	2024-10-18T15:01:37Z
dc.date.available	2024-10-18T15:01:37Z
dc.date.issued	2024-10-15
dc.description.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.
dc.identifier.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.
dc.identifier.uri	https://hdl.handle.net/1880/119985
dc.language.iso	en
dc.publisher.faculty	Graduate Studies
dc.publisher.institution	University of Calgary
dc.rights	University of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission.
dc.subject	Depression
dc.subject	Anxiety
dc.subject	Mental health disorder
dc.subject	Endoscopic retrograde cholangiopancreatography
dc.subject	Adverse events
dc.subject	Unplanned hospital encounter
dc.subject	Patient-reported experience measure
dc.subject.classification	Epidemiology
dc.title	Outcomes of Endoscopic Retrograde Cholangiopancreatography in Patients with Underlying Mental Health Disorders
dc.type	master thesis
thesis.degree.discipline	Medicine – Community Health Sciences
thesis.degree.grantor	University of Calgary
thesis.degree.name	Master of Science (MSc)
ucalgary.thesis.accesssetbystudent	I do not require a thesis withhold – my thesis will have open access and can be viewed and downloaded publicly as soon as possible.