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Background and Aims: Endoscopic retrograde cholangiopancreatography (ERCP) carries potential for serious adverse events and there is risk for unplanned health encounters following the procedure. The primary objective of this study was to identify the rate of 30-day hospital admission following outpatient ERCP in patients at elevated risk for post-ERCP pancreatitis based on patient- and procedure-related risk factors. We also explored whether pancreatitis rates and length of hospital stay differ with delayed hospitalization (vs admission immediately after ERCP) and identified factors associated with 30-day hospital admission., Methods: High-risk patients in the SVI trial who underwent outpatient ERCP were identified. The primary outcome was hospital admission within 30 days following outpatient ERCP. Patient and procedural factors associated with 30-day hospital admission were explored by univariable analysis followed by multivariable analysis, controlling for potential known confounders., Results: Among 768 patients at high risk for post-ERCP pancreatitis who underwent outpatient ERCP and were discharged home, 21.9% required hospitalization within 30 days. Compared to patients who underwent outpatient ERCP but were admitted immediately to the hospital post-procedure, patients who were discharged after ERCP and admitted later had a higher incidence of post-ERCP pancreatitis (40.5% vs 30.9%, P=0.04), moderate-severe post-ERCP pancreatitis (24.4% vs 13.8 %, P <0.01), and longer length of hospital stay (6.2 days vs 3.7 days, P<0.001). Factors associated with 30-day hospitalization included patient age (OR 0.98, 95% CI 0.97, 0.99), biliary stent placement (OR 1.62, 95% CI 1.05, 2.48), and attempt at pancreatic duct cannulation (OR 1.64, 95% CI 1.02, 2.64)., Conclusions: High-risk patients who undergo outpatient ERCP and are discharged home are at considerable risk for hospital admission within 30 days and have increased rate of pancreatitis and longer length of hospital stay compared to outpatients admitted to the hospital immediately following ERCP, and some factors may predict this outcome. These findings should influence decision making and informed consent when electing to proceed with high-risk ERCP, recognizing that patients with sphincter of Oddi dysfunction were over-represented in this cohort, which may limit generalizability to a typical ERCP practice., (Copyright © 2025 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)

Background: Cardiovascular autonomic neuropathy (CAN) and inflammation predict more severe outcomes in type 1 diabetes (T1D). However, the link between CAN and inflammation in T1D remains unclear. We examined associations between CAN measures and inflammatory biomarkers in individuals with T1D., Methods and Results: In a cross-sectional study, we measured cardiovascular autonomic reflex tests and heart rate variability (established CAN measures) and a panel of 39 inflammatory biomarkers, including soluble urokinase plasminogen activator receptor (suPAR), in T1D participants of the TINSAL-T1DN (Targeting Inflammation with Salsalate in Individuals with T1D Neuropathy) trial (n=57, discovery), and the PERL (Preventing Early Renal Loss in Diabetes) trial (n=468, validation). Amongst 39 inflammatory biomarkers measured in TINSAL-T1DN, suPAR levels had the strongest negative correlations with CAN measures: expiration/inspiration ( r =-0.48), Valsalva ( r =-0.28), 30:15 ( r =-0.37), SD of the normal RR interval ( r =-0.37), and root mean square of differences of successive RR intervals ( r =-0.31) (all P <0.05). Findings were validated in PERL. In unadjusted analyses, median suPAR levels significantly differed between the lowest and highest SD of the normal RR interval tertiles (3.79 versus 3.12 ng/mL, P <0.001) and root mean square of differences of successive RR intervals (3.76 versus 3.17 ng/mL, P <0.001). After adjusting for covariates (age, sex, hemoglobin A1c, and estimated glomerular filtration rate), median suPAR values remained significantly elevated in the lowest tertiles of SD of the normal RR interval ( P =0.004) and root mean square of differences of successive RR intervals ( P =0.006)., Conclusions: Amongst several inflammatory biomarkers, suPAR, an immune-mediated glycoprotein, has a singular association with CAN measures. The potential of targeting suPAR as a disease-modifying approach for CAN in T1D warrants further exploration., Registration: URL: https://www.clinicaltrials.gov; Unique identifiers: NCT02936843, NCT02017171.