Analysis Of Risk Factors And Establishment Of Risk Scoring System For Complications After Endoscopic Retrograde Cholangiopancreatography In Patients With Choledocholithiasis

Objective:Endoscopic retrograde cholangiopancreatography(ERCP)is an invasive procedure and its postoperative complications are unavoidable to a certain extent.Risk factors for postoperative complications after ERCP have been investigated with conflicting results.The purpose of this study was to evaluate the risk factors of complications after ERCP in patients with choledocholithiasis and to establish a risk scoring system to guide the screening of clinical high-risk patients.Methods:The Date of patients with choledocholithiasis who underwent ERCP for removing the stone in Shandong Provincial Hospital from August 2019 to December 2020 was retrospectively investigated.Extraction of patient disease factors and operational factors were analyzed using univariate and multivariate statistical analysis.The factors associated with postoperative complications were included in the logistic regression model,establishing a risk scoring system,to identify groups with low,medium,or high risk of complications.Results:Total complications occurred in 31(14.2%)of 219 patients with ERCP for choledocholithiasis,including 20(9.1%)post-ERCP pancreatitis(PEP),7(3.2%)biliary infection,3(1.4%)hemorrhage,and 1(0.5%)perforation.The incidence of PEP was associated with women(P=0.019),history of gallstone(P=0.002),albumin(ALB)(P=0.020),and international standardized ratio(INR)(P=0.007).Multivariate analysis showed that women(P=0.03,OR=3.157)and history of gallstone(P=0.002,OR=4.882)were independent risk factors for the occurrence of PEP,and high INR(P=0.028,OR=0.924)was a protective factor of PEP.The risk scoring system established by these three factors can better predict the incidence of PEP,with an AUC of 0.754.Risk stratification was performed by the scoring system,and patients with choledocholithiasis were divided into a low-risk group,medium-risk group,and highrisk group with the sensitivity of 70%and the specificity of 62.8%.The incidence of total postoperative complications was associated with history of gallstone(P=0.042),ALB(P=0.043),and INR(P=0.03).Factors with P-value<0.1 were analyzed by multivariate analysis.The sensitivity and specificity of the regression model built by factors history of gallstone(P=0.031,OR=2.383)and INR(P=0.066,OR=0.012)were 35.5%and 92%,with an AUC of 0.632.Conclusions:PEP is the most common complication after ERCP in patients with common bile duct stones.Female,history of gallstone,and low INR are independent risk factors for the occurrence of PEP.Meanwhile,history of gallstone and low INR are also independent risk factors for total postoperative complications.Patients with these risk factors for choledocholithiasis are a key demographic for the prevention of complications after ERCP.