Analysis Of Risk Factors For Post-ERCP Pancreatitis

Objective:To investigate the risk factors for post-ERCP pancreatitis(PEP). Independent risk factors for post-ERCP hyperamylasemia would also be found for detect the possible mechanism of PEP by compare the differences between two complication’s risk factors. According to the independent risk factors and the ORs, we try to create a simple scoring system can correctly predict PEP. Methods: Retrospective analysis the data of 4,234 ERCPs operated in Nanjing Drum Tower Hospital.Chi-square test is used for univariate analysis, and stepwise multivariate Logistic regression for variate analysis. We try to explore an excellent scores, with the best sensitivity and specificity by drawing the receiver operating characteristic curve.Results:226 PEPs(5.3%) occured. As the statistical results suggest, female, first ERCP, normal bilirubin, difficult cannulations and pancreatic duct contrast injection were independent risk factors for PEP, and the ORs(95% CIs)werel.449(1.087-1.932),1.745(1.206-2.526),1.917(1.433-2.566),3.317(2.219-4. 958),1.823(1.208-2.752).Young, diabetes, difficult cannulations, pancreatography, biliary stents and ENBD were risk factors of hyperamylasemia, and their OR(95%CI) were respectively 1.2 (1.092-1.533),0.614～0.410～0.918),1.990 (1.464～2.703), 2.009 (1.525～2.645),1.884 (1.517～2.341),1.613 (1.336～1.948).The best score to predict a PEP may be between 3and 4. Pancreatic stents should be placed when the risk scores are 6 or higher. Conclusion:Awareness of ERCP is a high risk operation, strict selection of ERCP operation indications, standardize the operation of the ERCP process, and prophylactic pancreatic duct stent are important measures to prevent PEP, so that safer ERCPs with less PEPs can be operated.