Risk models for post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP): smoking and chronic liver disease are predictors of protection against PEP.

Published

Journal Article

OBJECTIVES: We investigated which variables independently associated with protection against or development of postendoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) and severity of PEP. Subsequently, we derived predictive risk models for PEP. METHODS: In a case-control design, 6505 patients had 8264 ERCPs, 211 patients had PEP, and 22 patients had severe PEP. We randomly selected 348 non-PEP controls. We examined 7 established- and 9 investigational variables. RESULTS: In univariate analysis, 7 variables predicted PEP: younger age, female sex, suspected sphincter of Oddi dysfunction (SOD), pancreatic sphincterotomy, moderate-difficult cannulation (MDC), pancreatic stent placement, and lower Charlson score. Protective variables were current smoking, former drinking, diabetes, and chronic liver disease (CLD, biliary/transplant complications). Multivariate analysis identified seven independent variables for PEP, three protective (current smoking, CLD-biliary, CLD-transplant/hepatectomy complications) and 4 predictive (younger age, suspected SOD, pancreatic sphincterotomy, MDC). Pre- and post-ERCP risk models of 7 variables have a C-statistic of 0.74. Removing age (seventh variable) did not significantly affect the predictive value (C-statistic of 0.73) and reduced model complexity. Severity of PEP did not associate with any variables by multivariate analysis. CONCLUSIONS: By using the newly identified protective variables with 3 predictive variables, we derived 2 risk models with a higher predictive value for PEP compared to prior studies.

Full Text

Duke Authors

Cited Authors

  • DiMagno, MJ; Spaete, JP; Ballard, DD; Wamsteker, E-J; Saini, SD

Published Date

  • August 2013

Published In

Volume / Issue

  • 42 / 6

Start / End Page

  • 996 - 1003

PubMed ID

  • 23532001

Pubmed Central ID

  • 23532001

Electronic International Standard Serial Number (EISSN)

  • 1536-4828

Digital Object Identifier (DOI)

  • 10.1097/MPA.0b013e31827e95e9

Language

  • eng

Conference Location

  • United States