Risk factors of pancreatitis after endoscopic retrograde cholangiopancreatography in patients with biliary tract diseases

Abstract

Background To investigate the risk factors of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP) in patients with biliary tract diseases. Methods We retrospectively analyzed the clinical data of 480 patients who underwent ERCP for biliary tract diseases at the Affiliated Zhongshan Hospital of Dalian University from October 2011 to October 2016. The patients were divided into a study group (n = 75, with PEP) and a control group (n = 405, without PEP) based on whether they developed post-ERCP pancreatitis (PEP), and their clinical baseline data and intraoperative conditions were retrieved and compared. Then, factors associated with PEP were analyzed using logistic regression model, based on which a nomogram prediction model was constructed. The receiver operating characteristic (ROC) curve and calibration curve were used to evaluate the performance of the prediction model. Results Significant differences in age, sex, history of pancreatitis, history of choledocholithiasis, pancreatic duct imaging, pancreatic sphincterotomy, difficult cannulation, multiple cannulation attempts and juxtapapillary duodenal diverticula were observed between the two groups. Multivariate logistic regression analysis showed that age less than 60 years (OR, 0.477; 95% CI, 0.26–0.855), female sex (OR, 2.162; 95% CI, 1.220–3.831), history of pancreatitis (OR, 2.567; 95% CI, 1.218–5.410), history of choledocholithiasis (OR, 2.062; 95% CI, 1.162–3.658), pancreatic sphincterotomy (OR, 2.387; 95% CI, 1.298–4.390), pancreatic duct imaging (OR, 4.429; 95% CI, 1.481–13.242), multiple cannulation attempts (OR, 2.327; 95% CI, 1.205–4.493), difficult cannulation (OR, 2.421; 95% CI, 1.143–5.128), and JPD (OR, 2.002; 95% CI, 1.125–3.564) were independent risk factors for PEP. The nomogram for predicting the occurrence of PEP demonstrated an area under the ROC curve (AUC) of 0.787, and the calibration curves of the model showed good consistency between the predicted and actual probability of PEP. Conclusion Our results showed that age less than 60 years, female sex, history of pancreatitis, history of choledocholithiasis, pancreatic sphincterotomy, pancreatic duct imaging, multiple cannulation attempts, difficult cannulation and juxtapapillary duodenal diverticula were independent risk factors for PEP. In addition, the established nomogram demonstrated promising clinical efficacy in predicting PEP risk in patients who underwent ERCP for biliary tract diseases.

SII in combination with hsCRP predict the risk of pancreatitis after endoscopic retrograde cholangiopancreatography

“…The study also found that the proportion of women, elevated blood amylase measured three hours after surgery, and the maximum diameter of larger stones were independent risk factors for PEP.Previous studies mostly con rmed women as risk factors for pancreatitis after ERCP, which is consistent with this study [24][25][26] .The increased risk of PEP in female patients may be attributed to gallstones and sphincter of Oddi dysfunction (SOD).In the present study, patients with elevated blood amylase measured three hours after surgery were more likely to develop PEP, consistent with the ndings of Ze-Hui Lv et al [27] .In addition, the diameter size of bile duct stones was also correlated with the occurrence of PEP.Patients with large stone diameter may lead to biliary obstruction, cholestasis and bile duct injury due to natural stone discharge di culties, stone-embedded, surgery and other factors, which are prone to secondary bacterial infection and increase the risk of PEP.…”

Prediction for post-ERCP pancreatitis in non-elderly patients with common bile duct stones: a cross-sectional study at a major Chinese tertiary hospital (2015–2023)

“…Female, the history of pancreatitis, difficult intubation and EST in this study are all risk factors for PEP, which have been reported in multiple studies [ 18 – 20 ]. Interestingly, we found that patients with HBP were more likely to develop PEP in this study.…”

The distribution and antibiotic-resistant characteristics and risk factors of pathogens associated with clinical biliary tract infection in humans

“…To address these issues, the intraoperative collection of bile and bacterial culture samples can greatly improve the accuracy of diagnosis and treatment by providing a more comprehensive understanding of the patient’s condition ( Asukai et al, 2023 ; Papazyan et al, 2023 ). Moreover, although there are many methods to treat corresponding infectious complications, the effect is not satisfactory ( Chi et al, 2023 ). Therefore, it is necessary to actively prevent pathogen infection in patients, and important to understand the characteristics of pathogen infections and their associated risk factors.…”

“…Biliary infection in patients is common and has been associated with invasive clinical procedures, septicemia, intestinal barrier dysfunction, and gut bacteria translocation ( Chi et al, 2023 ; Ekpanyapong and Reddy, 2023 ). It continues to be a significant cause of severe complications and morbidity in patients, particularly in elderly patients with underlying comorbidities.…”