Development And Validation Of A Risk Prediction Model And Scoring System For Post-endoscopic Retrograde Cholangiopancreatography Pancreatitis

Background: A number of models have been proposed for the prediction of the risk of post-endoscopic retrograde cholangiopancreatography pancreatitis(PEP),but many include factors that are not assessed routinely.We aim to develop and validate a predictive model for the occurrence of PEP.Methods: The data of patients who underwent ERCP from Jan 01,2016 to May 16,2019(Training set and internal test set)and from May 17,2019 to December 25,2019(external test set)were retrospectively collected.The training set contained 1431 patients,the internal test set contained 612 patients,and the external test set contained342 patients.The performance of the model was validated in the two validation cohorts.Results:(1): A total of 342 patients were included for external test set,and 47(13.7%)developed PEP.Among them,55.0% were male,and 57.3% were >60 years of age;(2):The predicted model was: Logit(P=PEP)=-2.27 + 1.14 * Gastrectomy history –0.58 * DBIL + 0.31 * ALB + 0.67 * Pre-cut + 0.81 * Pancreatic guidewire passages-0.37 * Expert Operators-0.30 * Common bile duct stone + 1.50 * Nodular type of papillary orifice(or 0.79 * Villus type of papillary orifice);(3):The variables included in the scoring system were: gastrectomy history,high DBIL,high ALB,villus type of papillary orifice,nodular type of papillary orifice,pancreatic guidewire passages,per-cut,and expert operators.Total score >5 indicated high risk;(4): In the external test set,AUC was 0.718,sensitivity was 0.723,and specificity was 0.676.(5): In the internal test set,the probability of PEP was 2.9%,12.1%,and 22.2% in patients with low(<0),moderate(0-5),and high(>5)risk score,respectively.While in the external test set,those probability were 6.1%,17.0%,and 37.5% respectively.Conclusion: This study established a risk predict model and scoring system for predicting the risk of PEP using routinely measured clinical variables.Its application in routine work needs further investigation.