Abstract
Introduction: Pyogenic liver abscess (PLA) after Endoscopic Retrograde Cholangiopancreatography (ERCP) is a rare infectious adverse event. The association between post-ERCP PLA and endoscopic sphincterotomy has not been extensively studied. Methods: We conducted a retrospective study using the TriNetX platform by including patients without history of PLA who received ERCP between October 2015 and December 2020. Two groups were made: the endoscopic sphincterotomy (ES) group (patients who received ES during ERCP) and the control group (patients who did not receive ES). The primary outcome was the risk of developing PLA within 1 year of the index ERCP. The secondary outcomes included sepsis, broad-spectrum antibiotics use, need for PLA drainage, and post-ERCP mortality within one year of the index ERCP. Results: There were 169 patients (1.43%) in the ES group who developed PLA compared to 123 patients (1.04%) in the control group, Relative Risk (RR): 1.37, P-value = 0.007. A total of 241 patients (2.05%) in the ES group developed sepsis compared to 176 patients (1.49%) in the control group, RR: 1.37, P-value = 0.001. A total of 2,954 patients (25.1%) in the ES group received treatment with broad-spectrum antibiotics compared to 2,132 patients (18.1%) in the control group, RR: 1.5, P-value < 0.0001. There was no statistically significant difference in the need for PLA drainage (RR: 1.19, P-value = 0.34) or mortality (RR: 0.969, P-value = 0.49). Conclusion: ES during ERCP was associated with an increased risk for PLA, sepsis, and broad-spectrum antibiotics use. No mortality difference was found.