title: Predictors of complications after endoscopic retrograde cholangiopancreatography: a prognostic model for early discharge.
abstract: BACKGROUND
  Several studies have evaluated predictors for complications of endoscopic retrograde cholangiopancreatography (ERCP), but their relative importance is unknown. In addition, currently used blood tests to detect post-ERCP pancreatitis are inconsistent. The aim of this study was to determine predictors of post-ERCP complications that could discriminate between patients at highest and lowest risk of post-ERCP complications and to develop a model that is able to identify patients that can safely be discharged shortly after ERCP.
  
  
  METHODS
  In a single-center, retrospective analysis over the period 2002-2007, predictors of post-ERCP complications were evaluated in a multivariable analysis and compared with those identified from a literature review. A prognostic model was developed based on these risk factors, which was further evaluated in a prospective patient population.
  
  
  RESULTS
  From our retrospective analysis and literature review, we selected the eight most important risk factors for post-ERCP pancreatitis and cholangitis. In the prognostic model, the risk factors (precut) sphincterotomy, sphincter of Oddi dysfunction, younger age, female gender, history of pancreatitis, pancreas divisum, and difficult cannulation accounted for a score of 1 each, whereas primary sclerosing cholangitis (PSC) accounted for a score of 2. A sum score of 4 or more in the prognostic model was associated with a high risk of developing pancreatitis and cholangitis (27%; 6/22) in the prospective patient population, whereas a sum score of 3 or less was associated with a low to intermediate risk (8%; 20/252).
  
  
  CONCLUSIONS
  We identified specific patient- and procedure-related factors that are associated with post-ERCP complications. The prognostic model based on these factors is able to identify patients who can be safely discharged the same day after ERCP.
authors: Department of Gastroenterology and Hepatology, Erasmus MC/University Medical Center Rotterdam, Rotterdam, The Netherlands. s.m.jeurnink@students.uu.nl
authors: S M
authors: SM
authors: Jeurnink
authors: P D
authors: PD
authors: Siersema
authors: E W
authors: EW
authors: Steyerberg
authors: J
authors: J
authors: Dees
authors: J W
authors: JW
authors: Poley
authors: J
authors: J
authors: Haringsma
authors: E J
authors: EJ
authors: Kuipers
mesh_terms: D000328:Adult; D000368:Aged; D002404:Catheterization; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects* / Q000706:statistics & numerical data; D002761:Cholangitis / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D015999:Multivariate Analysis; D010195:Pancreatitis / Q000209:etiology*; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects / Q000706:statistics & numerical data; D015607:Stents