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The milestone for preventing post-ERCP pancreatitis using novel simplified predictive scoring system: a propensity score analysis

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Abstract

Background

Post-ERCP pancreatitis (PEP) with trans-papillary approach remains a major issue, and the multi-factorial etiology can lead to the development of unpredictable PEP. Therefore, the early identification of PEP is highly desirable to assist with the health cost containment, the reduction in unnecessary admissions, earlier appropriate primary care, and intensive care for preventing progression of severe pancreatitis. This study aimed to establish a simplified predictive scoring system for PEP.

Methods

Between January 1, 2012, and December 31, 2019, 3362 consecutive trans-papillary ERCP procedures were retrospectively analyzed. Significant risk factors were extracted by univariate, multivariate, and propensity score analyses, and the probability of PEP in the combinations of each factor were quantified using propensity score analysis. The results were internally validated using bootstrapping resampling.

Results

In the scoring system with four stratifications using combinations of only five extracted risk factors, the very high-risk group showed 28.79% (95% confidence interval [CI], 18.30%–41.25%; P < 0.001) in the predicted incidence rate of PEP, and 9.09% (95% CI, 3.41%–18.74%; P < 0.001) in that of severe PEP; although the adjusted prevalence revealed 3.74% in PEP and 0.90% in severe PEP, respectively. The prediction model had an area under the curve of 0.86 (95% CI, 0.82–0.89) and the optimism-corrected model as an internal validation had an area under the curve of 0.81 (95% CI, 0.77–0.86).

Conclusions

We established and validated a simplified predictive scoring system for PEP using five risk factors immediately after ERCP to assist with the early identification of PEP.

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Acknowledgements

The authors thank the Department of Surgery, and the Division of Gastroenterology and Hepatology for patient recruitment. The authors also thank Enago for the English language editing of this paper.

Funding

The authors declare that no funding support was received for this study.

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Authors and Affiliations

  1. Department of Endoscopy, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan

    Masafumi Chiba, Masayuki Kato, Nana Shimamoto, Takahiro Abe, Keisuke Kanazawa, Shintaro Tsukinaga, Hirobumi Toyoizumi & Kazuki Sumiyama

  2. Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan

    Yuji Kinoshita, Youichi Tomita, Masanori Nakano & Yuichi Torisu

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  1. Masafumi Chiba
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Contributions

Conception and design: MC and MK Performing endoscopic examinations: MC, MK, YK, NS, YT, TA, KK, ST, YT and HT Acquisition of data: MC, MK, YK, NS, YT and TA Statistical analysis: MC and MK Analysis and interpretation of the data: MC, MK, YK, NS, YT, TA, KK, ST, MN and YT Writing of the original paper: MC, MK and KS Revision of the paper: MC and MK Approval of the final draft submitted: All authors.

Corresponding author

Correspondence to Masafumi Chiba.

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Disclosures

Drs. Masafumi Chiba, Masayuki Kato, Yuji Kinoshita, Nana Shimamoto, Youichi Tomita, Takahiro Abe, Keisuke Kanazawa, Shintaro Tsukinaga, Masanori Nakano, Yuichi Torisu, Hirobumi Toyoizumi, and Kazuki Sumiyama have no conflicts of interest or financial ties to disclose.

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Chiba, M., Kato, M., Kinoshita, Y. et al. The milestone for preventing post-ERCP pancreatitis using novel simplified predictive scoring system: a propensity score analysis. Surg Endosc 35, 6696–6707 (2021). https://doi.org/10.1007/s00464-020-08173-4

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