Predicting the Risk of Post Endoscopic Retrograde Cholangiopancreatography Pancreatitis
Date
2023-07
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Abstract
Background Post- endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) can lead to significant morbidity and even mortality. The aim of this study was to develop a PEP prediction model using easily accessible patient- and procedure-related variables. Methods Using a multi center prospective ERCP registry, we conducted logistic regression using stepwise selection on several patient- and procedure-related variables that were determined a priori. Variables were included or excluded based on an initial alpha cut-off of 0.2. The final model was based on a combination of Bayesian information criterion (BIC) and Akaike's information criterion (AIC) performance, as well as on the inclusion of variables deemed to be of clinical relevance, while maintaining face validity. All available data was used for model development, with subsequent internal validation performed on bootstrapped data using 10-fold cross validation. Results From September 1, 2019 to January 16, 2022, 3021 ERCP procedures were enrolled and included in our study. There were 151 (5.0%) cases of PEP. Variables included in the final model were patient sex, patient age, pancreatic duct cannulation, native papilla status, presence of precut sphincterotomy, cannulation time, presence of biliary stricture, and pancreatic duct stenting. The final model had an AIC, BIC, and receiver operating characteristic (ROC) curve of 822.28, 886.77, and 0.79, respectively. Bootstrapped data using 800 replicates revealed a C-statistic of 0.78 and expected to observed (E:O) ratio of 1.003. Conclusion This study successfully established and internally validated a promising PEP predictive model using easily obtainable variables that are known at baseline or observed during the ERCP procedure. The model achieved an area under the curve of 0.79. External validation is required prior to clinical use.
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Keywords
endoscopic retrograde cholangiopancreatography, post-ERCP pancreatitis
Citation
Meng, Z. W. (2023). Predicting the risk of post endoscopic retrograde cholangiopancreatography pancreatitis (Master's thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.