Sugimoto Mitsuru, Takagi Tadayuki, Suzuki Tomohiro, Shimizu Hiroshi, Shibukawa Goro, Nakajima Yuki, Takeda Yutaro, Noguchi Yuki, Kobayashi Reiko, Imamura Hidemichi, Asama Hiroyuki, Konno Naoki, Waragai Yuichi, Akatsuka Hidenobu, Suzuki Rei, Hikichi Takuto, Ohira Hiromasa
Department of Gastroenterology, Fukushima Medical University, School of Medicine, Fukushima, Japan.
Department of Gastroenterology, Fukushima Rosai Hospital, Iwaki, Japan.
Elife. 2025 Jan 17;13:RP101604. doi: 10.7554/eLife.101604.
Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is a severe and deadly adverse event following ERCP. The ideal method for predicting PEP risk before ERCP has yet to be identified. We aimed to establish a simple PEP risk score model (SuPER model: Support for PEP Reduction) that can be applied before ERCP.
This multicenter study enrolled 2074 patients who underwent ERCP. Among them, 1037 patients each were randomly assigned to the development and validation cohorts. In the development cohort, the risk score model for predicting PEP was established via logistic regression analysis. In the validation cohort, the performance of the model was assessed.
In the development cohort, five PEP risk factors that could be identified before ERCP were extracted and assigned weights according to their respective regression coefficients: -2 points for pancreatic calcification, 1 point for female sex, and 2 points for intraductal papillary mucinous neoplasm, a native papilla of Vater, or the pancreatic duct procedures (treated as 'planned pancreatic duct procedures' for calculating the score before ERCP). The PEP occurrence rate was 0% among low-risk patients (≤0 points), 5.5% among moderate-risk patients (1-3 points), and 20.2% among high-risk patients (4-7 points). In the validation cohort, the C statistic of the risk score model was 0.71 (95% CI 0.64-0.78), which was considered acceptable. The PEP risk classification (low, moderate, and high) was a significant predictive factor for PEP that was independent of intraprocedural PEP risk factors (precut sphincterotomy and inadvertent pancreatic duct cannulation) (OR 4.2, 95% CI 2.8-6.3; p<0.01).
The PEP risk score allows an estimation of the risk of PEP prior to ERCP, regardless of whether the patient has undergone pancreatic duct procedures. This simple risk model, consisting of only five items, may aid in predicting and explaining the risk of PEP before ERCP and in preventing PEP by allowing selection of the appropriate expert endoscopist and useful PEP prophylaxes.
No external funding was received for this work.
内镜逆行胰胆管造影术（ERCP）后胰腺炎（PEP）是ERCP术后一种严重且致命的不良事件。目前尚未确定在ERCP术前预测PEP风险的理想方法。我们旨在建立一种可在ERCP术前应用的简单PEP风险评分模型（SuPER模型：支持降低PEP风险）。
这项多中心研究纳入了2074例行ERCP的患者。其中，1037例患者被随机分配至模型开发队列和验证队列。在模型开发队列中，通过逻辑回归分析建立预测PEP的风险评分模型。在验证队列中，评估该模型的性能。
在模型开发队列中，提取了5个在ERCP术前可识别的PEP风险因素，并根据各自的回归系数赋予权重：胰腺钙化-2分，女性1分，导管内乳头状黏液性肿瘤、Vater乳头或胰管操作（在ERCP术前计算评分时视为“计划性胰管操作”）2分。低风险患者（≤0分）的PEP发生率为0%，中风险患者（1 - 3分）为5.5%，高风险患者（4 - 7分）为20.2%。在验证队列中，风险评分模型的C统计量为0.71（95%CI 0.64 - 0.78），被认为是可接受的。PEP风险分类（低、中、高）是PEP的一个显著预测因素，独立于术中PEP风险因素（预切开括约肌切开术和意外胰管插管）（OR 4.2，95%CI 2.8 - 6.3；p<0.01）。
PEP风险评分能够在ERCP术前评估PEP风险，无论患者是否接受过胰管操作。这个仅由5项组成的简单风险模型，可能有助于在ERCP术前预测和解释PEP风险，并通过选择合适的内镜专家和有效的PEP预防措施来预防PEP。
本研究未接受外部资金。
