Predictors of pancreatitis after endoscopic retrograde cholangiopancretography: a prognostic model for early discharge.

PREDICTORS OF PANCREATITIS AFTER ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY: A PROGNOSTIC MODEL FOR EARLY DISCHARGE. BACKGROUND Pancreatitis is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP). Several studies have evaluated predictors for pancreatitis after ERCP but their relative importance is still unknown and current blood tests to predict the severity of post-ERCP pancreatitis are inconsistent. Simple methods to allow patients at low risk to be discharged on the same day of their procedure are needed. The aim of this study was to combine clinical predictors of post-ERCP complications and early assessment of amylasemia in order to to identify patients that can safely be discharged shortly after ERCP. PATIENTS AND METHODS In a single-center, post ERCP outcome of 100 patients was retrospectively analyzed over the period May 2009-May 2012. All patients received ceftriaxone, gaba-mesylate and somatostatine post ERCP therapy. Possible predictors of post-ERCP pancreatitis, early regression of hyperamylasemia and need of TC scan were evaluated. ROC curves analysis and multivariate regression analysis were performed to obtain prognostic models. RESULTS Pancreatitis occurred in 4% of ERCPs. Hyperamylasemia 4 hours after ERCP was found to be the only predictor of post-ERCP pancreatitis (AUC=0.80; p=0.05). Persistence of hyperamylasemia after 3 days was independently predicted by diagnosis of ampulloma (OR=47.12 [95%CI 2.12-899.1]), inflammatory papilla stenosis (OR=12.05 [95%CI 1.96-73.96]), age (OR=0.94 [95%CI 0.90-0.98]) and hyperamylasemia at 4 hours after ERCP (OR=1.002 [95%CI 0.999-1.004]). Need of TC scan was associated to brushing for cytology and to naso-biliary tube positioning but only this last procedure revealed to be an independent predictor (OR=4.8 [95%CI 0.99-25.6]). CONCLUSIONS Hyperamylasemia at 4 hours after ERCP is predictive of pancreatitis but it alone is not sufficient to guarantee a safe early discharge. Diagnosis of ampulloma, inflammatory papilla stenosis and age should be considered when planning an early discharge. Naso-biliary tube positioning is associated to the need to further diagnosis with TC scan.