Alcohol Use and Cigarette Smoking as Risk Factors for Post–Endoscopic Retrograde Cholangiopancreatography Pancreatitis

Abstract

Background & Aims Alcohol use and cigarette smoking associate with various pancreatic diseases, but it is not known whether they associate with post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). We performed a retrospective case-control study to determine if these activities increase the risk of PEP. Methods We identified 7,638 patients that had undergone ERCP in the University of Michigan Health System and applied exclusion criteria to identify 123 with PEP. We randomly selected 308 age- and gender-stratified controls (2.5-fold case sample); after applying exclusion criteria 248 remained. In a masked fashion, we collected data for alcohol use, cigarette smoking, and 5 internal control variables: suspected sphincter of Oddi dysfunction (SOD), pancreatic sphincterotomy, moderate/difficult cannulation, ≥ 2 pancreatic injections and pancreatic stent placement. Results The univariate model showed an increased frequency of PEP in current drinkers (P<0.001), former drinkers (P<0.001) and former smokers (P<0.001), as well as patients who were suspected of having SOD (P<0.001), had undergone pancreatic sphincterotomy (P<0.001), had a moderate/difficult cannulation (P=0.001), and/or had ≥2 pancreatic injections (P=0.007). The frequency of PEP was reduced in current smokers (P<0.001). The multivariate model showed that the only independent significant predictors of PEP were current drinking (OR=4.70, 95% CI 2.60–8.50, P<0.0001), former cigarette smoking (OR=3.29, 95% CI 1.28–8.44, P<0.013), suspected SOD (OR= 3.69, 95% CI 1.94–7.02, P<0.001), and pancreatic sphincterotomy (OR=5.91, 95% CI 2.04–17.14, P=0.001). Conclusions Current alcohol use and potentially former cigarette smoking are new risk factors for PEP. It is important to consider these variables in designing PEP prevention trials.

Supporting information retrieval from electronic health records: A report of University of Michigan’s nine-year experience in developing and using the Electronic Medical Record Search Engine (EMERSE)

“…3548-50 The research studies that EMERSE has supported span many topic areas in health sciences. 355152 Several papers explicitly acknowledged the enabling role that EMERSE played in the studies which allowed the investigators to “systematically identify data within the electronic medical record,” 33 and helped to accomplish “a standardized, accurate, and reproducible electronic medical record review.” 3637 Table 1 exhibits 14 peer-reviewed publications appearing in 2014 alone that were supported by the use of EMERSE. A full list of the publications supported by EMERSE to date, of which we are aware, is provided in Appendix B.…”

“…Several studies enabled by the system published their search terms used to ensure other researchers could replicate the results. 3658-64 As more and more studies now leverage EHR data for clinical and translational research, the development of a central repository for search terms used in extracting data from EHRs could serve as a useful and sharable knowledge base.…”

“…As part of the results validation process several studies explicitly examined the efficacy of EMERSE and concluded that the system was instrumental in ensuring the quality of chart review while significantly reducing manual efforts. 333637 To the best of our knowledge, this is the first comprehensive description of an EHR search tool that has been used in a production setting by many real end users for multiple years and for a wide variety of clinical, operational, and research tasks. We believe our experience of designing, building, maintaining, and disseminating EMERSE will provide useful insights to the researchers who have a similar need for an HER search engine and will help potential users of such an EHR search engine to understand what types of problems that such tools can help solve.…”

Do Larger Periprocedural Fluid Volumes Reduce the Severity of Post–Endoscopic Retrograde Cholangiopancreatography Pancreatitis?

“…Newly collected data were added to our established data set. 10 PEP severity was defined as mild or moderate-severe based on criteria by Cotton et al 15 We used previously described definitions for multiple variables, 2010 including cigarette-smoking and alcohol-use, cardiovascular disease (see review by Anderson et al 21 ), suspected SOD, pancreatic sphincterotomy, ≥2 pancreatic injections, moderate-difficult cannulation, pancreatic stent placement, and 19 variables comprising the Charlson Comorbidity Score. 22 …”

“…We used methods identical to our previous studies 10,20 to search the entire electronic medical record for data of interest, to reconcile variations in the data recorded in the electronic medical record, and to collect, tabulate and analyze data. 10, 20 In brief, data were collected with preprinted data collection forms, tabulated with spreadsheet software (Excel; Microsoft) and analyzed with Pro JMP 10 (SAS Institute, Cary, NC, USA) and Stata 12 (StataCorp, College Station, TX) statistical software. Descriptive statistics were compiled on all variables to evaluate variable distributions prior to modeling.…”