| Objectives: In this study,we investigated the incidence,severity and risk factors for acute pancreatitis after percutaneous transhepatic metallic stents placement in patients with distal malignant biliary obstruction(DMBO),and to develop and validate a clinical model for predicting the risk of acute pancreatitis.Methods: The clinical data of 379 patients with DMBO who received percutaneous transhepatic metallic stents placement in Shengjing Hospital of China Medical University from January 2016 to April 2022 were retrospectively analyzed.A total of 340 patients who met the inclusion and exclusion criteria were included in the study.These patients were divided into the pancreatitis group and the non-pancreatitis group according to whether acute pancreatitis occurred after percutaneous transhepatic biliary stenting(PTBS).The incidence and severity of postoperative acute pancreatitis were assessed according to the 2012 revised Atlanta classification of acute pancreatitis.Associated risk factors of postoperative acute pancreatitis were screened by univariate analysis and then further assessed by multivariate logistic regression analysis,and subgroup analysis was performed on the independent risk factor obtained.The Nomogram model was constructed according to the regression results,the predictive value and clinical benefit of Nomogram were validated with receiver operating characteristic(ROC),enhanced bootstrap method and decision curve analysis(DCA).Results: All patients were successfully treated with PTBS,including 185 males and 155 females,with an age range of 40 to 95 years old.Acute pancreatitis occurred in 66(19.4%)patients,including one patient with severe acute pancreatitis,and others had mild acute pancreatitis.Based on the results of univariate analysis,high body mass index(≥24 kg/m2)(P=0.18),preoperative pancreatic parenchyma atrophy(P=0.017),main pancreatic duct(MPD)dilation(P=0.01),pancreatic cancer(P=0.01),one-step operation(P=0.06),operation duration(P=0.17),open-loop stent(P=0.16),stent length>6cm(P=0.01),10 mm diameter stent(P=0.04),stent placement across the duodenal papilla(P<0.001)were statistically significant influence factors associated with acute pancreatitis after PTBS(P<0.2).Multivariate logistic regression analysis showed that stent placement across the papilla of Vater(OR=3.63,95%CI: 1.76-7.52;P<0.001)was an independent risk factor for acute pancreatitis after percutaneous transhepatic metallic stents placement,while preoperative MPD dilatation(OR=0.38,95%CI: 0.21-0.68;P=0.001)and stent diameter of 10mm(OR=0.36,95% CI: 0.16-0.85;P=0.023)were negative predictive factors.ROC revealed that the Nomogram model carries excellent discrimination ability(AUC=0.716).The enhanced bootstrap calibration graph and DCA suggested good potential of our Nomogram in clinical uses.Multivariate logistic regression analysis in the high-risk subgroup showed that preoperative MPD dilatation(OR=0.37,95% CI: 0.20-0.67;P=0.001),involvement of the sphincter of Oddi at the site of biliary obstruction(OR=0.53,95% CI: 0.29-0.97;P=0.039)and stent diameter of 10 mm(OR=0.31,95% CI:0.13-0.77;P=0.012)were protective factors.Conclusion: Acute pancreatitis was a relatively high complication after percutaneous transhepatic metallic stents placement in patients with DMBO,but it was mostly mild.Stent placement across the duodenal papilla was an independent risk factor for acute pancreatitis.Preoperative main pancreatic duct dilatation and 10 mm diameter stent could reduce the risk of acute pancreatitis.The Nomogram model according to the above factors can be used as a potential prognostic tool to predict the risk of postoperative pancreatitis and timely identify high-risk patients.For high-risk subgroup patients of stent placement across the papilla of Vater,preoperative MPD dilatation,involvement of the sphincter of Oddi at the site of biliary obstruction and 10 mm diameter stent could reduce the risk of acute pancreatitis. |
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