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Surgical Endoscopy
Published in: Surgical Endoscopy 9/2011

Open Access 01-09-2011

Predictors of complications after endoscopic retrograde cholangiopancreatography: a prognostic model for early discharge

Authors: S. M. Jeurnink, P. D. Siersema, E. W. Steyerberg, J. Dees, J. W. Poley, J. Haringsma, E. J. Kuipers

Published in: Surgical Endoscopy | Issue 9/2011

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Abstract

Background

Several studies have evaluated predictors for complications of endoscopic retrograde cholangiopancreatography (ERCP), but their relative importance is unknown. In addition, currently used blood tests to detect post-ERCP pancreatitis are inconsistent. The aim of this study was to determine predictors of post-ERCP complications that could discriminate between patients at highest and lowest risk of post-ERCP complications and to develop a model that is able to identify patients that can safely be discharged shortly after ERCP.

Methods

In a single-center, retrospective analysis over the period 2002–2007, predictors of post-ERCP complications were evaluated in a multivariable analysis and compared with those identified from a literature review. A prognostic model was developed based on these risk factors, which was further evaluated in a prospective patient population.

Results

From our retrospective analysis and literature review, we selected the eight most important risk factors for post-ERCP pancreatitis and cholangitis. In the prognostic model, the risk factors (precut) sphincterotomy, sphincter of Oddi dysfunction, younger age, female gender, history of pancreatitis, pancreas divisum, and difficult cannulation accounted for a score of 1 each, whereas primary sclerosing cholangitis (PSC) accounted for a score of 2. A sum score of 4 or more in the prognostic model was associated with a high risk of developing pancreatitis and cholangitis (27%; 6/22) in the prospective patient population, whereas a sum score of 3 or less was associated with a low to intermediate risk (8%; 20/252).

Conclusions

We identified specific patient- and procedure-related factors that are associated with post-ERCP complications. The prognostic model based on these factors is able to identify patients who can be safely discharged the same day after ERCP.
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Metadata
Title
Predictors of complications after endoscopic retrograde cholangiopancreatography: a prognostic model for early discharge
Authors
S. M. Jeurnink
P. D. Siersema
E. W. Steyerberg
J. Dees
J. W. Poley
J. Haringsma
E. J. Kuipers
Publication date
01-09-2011
Publisher
Springer-Verlag
Published in
Surgical Endoscopy / Issue 9/2011
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-011-1638-9

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