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The milestone for preventing post-ERCP pancreatitis using novel simplified predictive scoring system: a propensity
Masafumi Chiba1, Masayuki Kato2, Yuji Kinoshita3
1Department of Endoscopy, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan. ccl0972009720@gmail.com.
Insights
A new scoring system can predict post-ERCP pancreatitis (PEP) risk after endoscopic retrograde cholangiopancreatography (ERCP). This tool aids in early identification of patients at high risk for PEP, allowing for timely interventions.
Area of Science:
- Gastroenterology
- Medical Informatics
- Clinical Prediction Models
Background:
- Post-ERCP pancreatitis (PEP) is a significant complication of the trans-papillary approach during ERCP.
- The multi-factorial etiology of PEP makes its development unpredictable.
- Early identification of PEP is crucial for cost containment, reducing admissions, and preventing severe pancreatitis progression.
Purpose of the Study:
- To develop and validate a simplified predictive scoring system for PEP.
- To enable early identification of patients at risk for PEP immediately after ERCP.
Main Methods:
- Retrospective analysis of 3362 trans-papillary ERCP procedures performed between January 1, 2012, and December 31, 2019.
- Identification of significant risk factors using univariate, multivariate, and propensity score analyses.
- Quantification of PEP probability using propensity score analysis and internal validation via bootstrapping.
Main Results:
- A scoring system utilizing five risk factors was established, with four risk stratifications.
- The very high-risk group demonstrated a predicted PEP incidence of 28.79% and severe PEP incidence of 9.09%.
- The prediction model achieved an area under the curve (AUC) of 0.86, with an AUC of 0.81 after internal validation.
Conclusions:
- A simplified predictive scoring system for PEP has been successfully established and validated.
- This system uses five risk factors identified immediately after ERCP.
- The scoring system facilitates the early identification of PEP, aiding clinical management.
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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