Risk Of Endoscopic Retrograde Cholangiopancreatography In Patients With Asymptomatic Common Bile Duct Stones:Propensity Score Matching Analysis

Objective:To identify the incidence of post-endoscopic retrograde cholangio pancreatography pancreatitis in patients with asymptomatic common bile duct sto nes and to explore the risk factors of PEP.Methods:365 patients with common bile duct stones who underwent therapeutic ERCP in Changshu Hospital affiliated to Soochow University from December 1,2018 to December 1,2022 were included in our study.They were divided into two groups:63 in the asymptomatic group and 302 in the symptomatic group.Using age,sex,cannulation time,pre-cut sphincterotomy,extent of Endoscopic sphincterotomy(EST),pancreatic duct insertion with guidewire,dilated common bile duct,periampullary diverticula(PAD)as covariates,Propensity score matching(PSM)was applied to match two groups in 1:5 ratio.Comparing the incidence of related complications after ERCP in two groups to identify the risk of ERCP in asymptomatic common bile duct stones.Univariate and multivariate analysis of all PEP patients was performed to explore the risk factors of PEP.Results:1.63 patients were included in the asymptomatic group and 145 patients in the symptomatic group after propensity score matching analysis.2.A total of 55(15.1%)patients had ERCP-related complications,including PEP,cholangitis,perforation and bleeding.The overall complication rate in the asymptomatic group was higher than in the control group(30.2%vs 11.9%,P<0.01).PEP was the most common complication(37/365,10.1%).In all PEP patients,32 cases(86.5%)were mild,and the severity in both groups was similar(14/1/1 vs 18/2/1,P>0.05).The incidence of PEP in the asymptomatic group was higher than in the symptomatic group(25.4%vs 7.0%,P<0.01).3.After PSM,the overall complication rate was higher in the asymptomatic group than in the control group(30.2%vs 14.5%,P<0.01),and the incidence of PEP was still significantly higher than that in the control group(25.4%vs 7.6%,P<0.01).The Average Treatment Effect on the Treated(ATT)showed a significant increase in the risk of PEP in the asymptomatic group(ATT=0.1799,95%confidence interval:0.066-0.293,P<0.05).4.Multivariate regression analysis identified asymptomatic common bile duct stones(odds ratio=5.374,95%confidence interval:2.212-13.055,P<0.01),PAD(o dds ratio=2.988,95%confidence interval:1.265-7.059,P<0.05),pancreatic duct ins ertion with guidewire>2 times(odds ratio=0.028,95%confidence interval:0.03-0.247,P<0.05),and mechanical lithotripter(odds ratio=30.925,95%confidence inter val:3.684-259.615,P<0.05)as independent risk factors for PEP.Conclusion:The incidence of complications after ERCP was higher in patients with asymptomatic common bile duct stones,especially in PEP,but there was no significant difference in the severity of PEP.Asymptomatic common bile duct stones,PAD,mechanical lithotripsy,and pancreatic duct insertion with guidewire>2 times were independent risk factors of PEP.