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Published on: September 13, 2022
Predictors of Post-ERCP Pancreatitis (P.E.P.) in Choledochal Lithiasis Extraction
Adrian Boicean1,2, Victoria Birlutiu1,2, Cristian Ichim1,2
1County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania.
Insights
Post-ERCP pancreatitis (PEP) risk is higher in women and predicted by elevated CRPR, TBIR, and NLR. Lower admission total bilirubin levels also indicate increased PEP risk in patients undergoing ERCP for bile duct stones.
Area of Science:
- Gastroenterology
- Endoscopic Procedures
- Pancreatology
Background:
- Post-ERCP pancreatitis (PEP) is a frequent complication of endoscopic retrograde cholangiopancreatography (ERCP).
- Predicting PEP is crucial for patient management and optimizing ERCP procedures.
Purpose of the Study:
- To identify predictors of post-ERCP pancreatitis (PEP) using demographic data and emergency blood test values.
- To evaluate the association between specific ERCP techniques and PEP risk.
Main Methods:
- Retrospective analysis of 134 patients undergoing ERCP for choledochal lithiasis.
- Comparison of demographic and laboratory data between patients with and without PEP.
- Statistical analysis including odds ratios (OR) and confidence intervals (CI) to assess risk factors.
Main Results:
- Women had an increased risk of PEP (OR: 2.893).
- Manipulation with Dormia probe and dilatation balloon, without biliary stent placement, reduced PEP risk (OR: 0.346).
- Elevated post-ERCP CRPR (OR: 4.337), TBIR (OR: 4.004), and NLR (OR: 3.281) were significant predictors of PEP.
- Lower total bilirubin levels on admission predicted PEP (OR: 5.262).
Conclusions:
- Demographic factors and specific ERCP techniques influence PEP risk.
- Certain blood test ratios and levels post-ERCP, along with admission bilirubin, are valuable predictors of PEP.
- These findings can aid in early identification and management of patients at high risk for PEP.
Abstract:
In the present era, post-ERCP pancreatitis (PEP) stands out as one of the most commonly occurring complications associated with endoscopic choledochal lithiasis extraction. The ability to predict the occurrence of such an event, particularly by utilizing absolute values and ratio dynamics of the emergency blood tests, constitutes the primary step in effectively managing a patient with a complex pathology. The study involved 134 patients who performed ERCP to extract choledochal lithiasis (n = 48 with PEP and n = 86 without PEP). The results revealed increased risks of post-ERCP pancreatitis in women and lower risks in those who benefited from manipulation of the main bile duct with the Dormia probe and dilatation balloon (OR: 2.893 CI 95%: 1.371-6.105, p = 0.005 and respectively OR: 0.346 CI 95%: 0.156-0.765, p = 0.009), without biliary stent placement. Moreover, the results brought novel elements to the literature, showing that higher values of CRPR (OR: 4.337 CI 95%: 1.945-9.668; p < 0.001), TBIR (4.004 CI 95%: 1.664-9.634; p = 0.002) and NLR post-ERCP (3.281 CI 95%: 1.490-7.221; p = 0.003) are predictive for PEP. Nevertheless, lower total bilirubin levels upon admission are predictive of PEP with an OR of 5.262 (95% confidence interval: 2.111-13.113, p < 0.001).
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