Beran Azizullah, Aboursheid Tarek, Ali Adel Hajj, Nayfeh Tarek, Albunni Hashem, Vargas Alejandra, Mohamed Mouhand F, Elfert Khaled, Shaear Mohammad, Obaitan Ite, Saleem Nasir, Ahmed Awais, Gromski Mark A, DeWitt John M, Al-Haddad Mohammad, Watkins James L, Fogel Evan, Easler Jeffrey J
Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana.
Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, Illinois.
Clin Gastroenterol Hepatol. 2024 Dec 16. doi: 10.1016/j.cgh.2024.11.014.
BACKGROUND & AIMS: Pancreatitis is the most common serious adverse event associated with endoscopic retrograde cholangiopancreatography (ERCP). This meta-analysis aimed to precisely assess the risk factors for post-ERCP pancreatitis (PEP).
We searched electronic databases for studies that assessed risk factors for PEP after adjusting for ≥3 risk factors, including at least one pre-specified patient-related and one procedure-related risk factor, and reported the data as adjusted odds ratios (ORs) with 95% confidence intervals. Meta-analyses were conducted using a random-effects model, and pooled adjusted ORs for risk factors reported in ≥3 studies were constructed.
A total of 159 studies with 315,580 ERCPs were included, assessing 31 unique risk factors (20 patient-related and 11 procedure-related). Key patient-related predictors of PEP were age ≤60 years (OR, 1.81; high credibility), prior acute pancreatitis (OR, 2.59; moderate), age ≤40 years (OR, 2.33; moderate), asymptomatic choledocholithiasis (OR, 4.76; low), prior PEP (OR, 4.40; low), sphincter of Oddi dysfunction (OR, 3.11; low), and female gender (OR, 1.70; low). Key procedure-related predictors of PEP were any guidewire passage into the pancreatic duct (PD) (OR, 2.18; high), first ERCP with a native papilla (OR, 1.91; high), endoscopic papillary balloon dilation of an intact papilla (OR, 2.91; moderate), pancreatic acinarization (OR, 4.23; low), any PD cannulation (OR, 2.73; low), pancreatic sphincterotomy (OR, 2.64; low), difficult cannulation (OR, 2.60; low), any pancreatogram (OR, 2.40; low), and precut sphincterotomy (OR, 1.98; low).
Our meta-analysis focused on adjusted risk factors to provide precise estimates of the most important risk factors for PEP. Incorporating our results into a prediction model may reliably help identify high-risk patients, optimize informed consent, and guide prevention and management strategies for PEP.
胰腺炎是与内镜逆行胰胆管造影术（ERCP）相关的最常见严重不良事件。本荟萃分析旨在精确评估ERCP术后胰腺炎（PEP）的危险因素。
我们在电子数据库中搜索了对≥3个危险因素进行调整后评估PEP危险因素的研究，包括至少1个预先指定的患者相关危险因素和1个操作相关危险因素，并将数据报告为具有95%置信区间的调整比值比（OR）。采用随机效应模型进行荟萃分析，并构建≥3项研究报告的危险因素的合并调整OR。
共纳入159项研究，涉及315,580例ERCP，评估了31个独特的危险因素（20个患者相关因素和11个操作相关因素）。PEP的关键患者相关预测因素为年龄≤60岁（OR，1.81；高可信度）、既往急性胰腺炎（OR，2.59；中等）、年龄≤40岁（OR，2.33；中等）、无症状胆总管结石（OR，4.76；低）、既往PEP（OR，4.40；低）、Oddi括约肌功能障碍（OR，3.11；低）和女性（OR，1.70；低）。PEP的关键操作相关预测因素为任何导丝进入胰管（PD）（OR，2.18；高）、首次对天然乳头进行ERCP（OR，1.91；高）、对完整乳头进行内镜乳头球囊扩张（OR，2.91；中等）、胰腺腺泡化（OR，4.23；低）、任何PD插管（OR，2.73；低）、胰腺括约肌切开术（OR，2.64；低）、插管困难（OR，2.60；低）、任何胰管造影（OR，2.40；低）和预切开括约肌切开术（OR，1.98；低）。
我们的荟萃分析聚焦于调整后的危险因素，以精确估计PEP最重要的危险因素。将我们的结果纳入预测模型可能有助于可靠地识别高危患者，优化知情同意，并指导PEP的预防和管理策略。
