CT severity of post-ERCP pancreatitis: results from a single tertiary medical center.
OBJECTIVE
To evaluate the CT severity of post-ERCP pancreatitis (PEP) and determine the association between radiographic and clinical severity.


METHODS
There were 1332 patients admitted to the hospital with suspicion for PEP after undergoing ERCP as outpatients over a 10-year period, of whom 84 (6.3%) patients underwent at least one contrast-enhanced CT scan while hospitalized were evaluated. All CT scans were evaluated by two radiologists, and the modified CT severity index (MCTSI) score was calculated. Demographic, clinical, and procedural data as well as clinical severity parameters including systemic inflammatory response syndrome, organ failure, need for ICU, need for intervention, length of hospital stay, and mortality were recorded. Statistical analysis was performed using the χ (2) and Student's t test or ANOVA and logistic regression analysis.


RESULTS
Patients were predominantly females (70%) with a mean age of 46.5 years (range 20-86). The most common indication for ERCP was sphincter of Oddi dysfunction. MCTSI was graded as mild in 45 (53.6%), moderate in 36 (42.8%), and severe in 3 (3.6%) patients. The interobserver agreement was excellent (κ: 0.91, p < 0.0001) for MCTSI. The duration of ERCP (p = 0.005) was the only risk factor for PEP that significantly correlated with the MCTSI score. Increasing MCTSI was significantly associated with hospital length of stay.


CONCLUSIONS
PEP is typically a mild disease by radiologic and clinical criteria. Longer duration of ERCP is a risk factor for severe radiologic PEP. Severe radiographic PEP is associated with significantly longer hospital length of stay.
Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, 601 N. Caroline Street, Baltimore, MD, 21287, USA, rwoods@gmail.com.
Ryan W
RW
Woods
Venkata S
VS
Akshintala
Vikesh K
VK
Singh
Abeer
A
Almulla
Vinshi Naz
VN
Khan
Rukshana
R
Cader
Elliot K
EK
Fishman
Atif
A
Zaheer
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D003287:Contrast Media; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D007472:Iohexol; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D015588:Observer Variation; D010179:Pancreas / Q000000981:diagnostic imaging; D010195:Pancreatitis / Q000000981:diagnostic imaging* / Q000209:etiology; D011856:Radiographic Image Enhancement / Q000379:methods; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D062606:Tertiary Care Centers / Q000706:statistics & numerical data*; D014283:Triiodobenzoic Acids; D055815:Young Adult
D003287:Contrast Media; D014283:Triiodobenzoic Acids; D007472:Iohexol; C044834:iodixanol