Impact of timing of access to endoscopic drainage and social determinants of health on the prognosis of patients with periampullary cancer diagnosed through jaundice: a multicenter retrospective study

Background: Factors influencing the timing to endoscopic retrograde cholangiopancreatography (ERCP) drainage in patients with periampullary cancer diagnosed due to jaundice, as well as the impact of drainage delay on survival, remain poorly understood. Objectives: To evaluate the impact of clinical and social determinants on time to ERCP and 1-year mortality in patients with periampullary cancer diagnosed due to jaundice. Design: Multicenter retrospective study. Methods: All ERCP performed for periampullary cancer diagnosed due to jaundice between January 2010 and December 2020 were included. Determinants associated with early ERCP (defined as ⩽3 days from diagnostic imaging) were assessed using logistic regression. Factors associated with 1-year mortality were analyzed using a multivariate Cox model. Results: Five hundred ninety-four ERCPs were performed, with a median time to intervention of 9 days. Early ERCP (⩽3 days) was associated with improved survival in univariate analysis (hazard ratio (HR) = 0.66; 95% confidence interval (CI) (0.45-0.96)), but not in the multivariate model. In multivariate analysis, acute cholangitis (HR = 1.51; 95% CI (1.03-2.22)), age (HR = 1.03; 95% CI (1.01-1.04)), metastatic disease (HR = 1.76; 95% CI (1.21-2.57)), and ERCP technical success (HR = 0.59; 95% CI (0.42-0.83)) were associated with 1-year mortality. Only total bilirubin (odds ratio (OR) = 2.24; 95% CI (1.18-4.23)) and prothrombin time (OR = 1.02; 95% CI (1.01-1.04)) influenced time to ERCP. Social determinants had no significant impact on time to ERCP or overall survival. Conclusion: Time to ERCP does not appear to influence overall survival in patients with periampullary cancer diagnosed due to jaundice. Overall survival and time to ERCP seem to be influenced by clinical factors, with no apparent effect of social determinants.