# A Clinical Scoring Model to Predict Post‐Endoscopic Retrograde Cholangiopancreatography Pancreatitis in Biliary Endoscopic Retrograde Cholangiopancreatography for Patients With Intact Papilla: A Large Multicenter Prospective Cohort Study

## TL;DR

This study developed a clinical scoring model to predict the risk of post-ERCP pancreatitis in patients with intact papilla undergoing biliary ERCP.

## Contribution

A novel clinical scoring model was developed using a large multicenter prospective cohort to predict post-ERCP pancreatitis risk.

## Key findings

- The model included 11 factors and stratified patients into low, intermediate, and high-risk groups for post-ERCP pancreatitis.
- The model's area under the ROC curve was 0.729, indicating moderate predictive accuracy.
- PEP incidence varied significantly across risk groups (1.6%, 6.0%, and 17.7%).

## Abstract

The risk of post‐endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) needs to be predicted in order to take adequate preventive measures in individual cases. The aim of this study was to develop a clinical prediction rule for PEP in biliary ERCP for patients with intact papilla.

We conducted a multicenter prospective cohort study to investigate the adverse events of biliary ERCP in patients with intact papilla. A total of 3739 patients were prospectively enrolled at 36 hospitals in western Japan between April 2017 and March 2018. Data on patient‐related factors, operator‐related factors, procedure‐related factors, and preventative measures were collected. A multivariable logistic regression was used to identify predictors for PEP, and a scoring model was developed.

The scoring model included 11 factors: age younger than 50 years (2 points), female sex (1 point), ASA 3 (‐2 points), cholangitis (‐1 point), hypoamylasemia (‐1 point), obstruction of the main pancreatic duct at the pancreatic head (‐2 points), cannulation time >20 min (1 point), guidewire insertion into the pancreatic duct (3 points), intraductal ultrasonography (1 point), biopsy (1 point), and total procedure time >60 min (2 points). The area under the receiver operating characteristic curve of this model was 0.729. All cases were stratified into three groups according to the total score: low‐risk, intermediate‐risk, and high‐risk groups, with an incidence of PEP of 1.6%, 6.0%, and 17.7%, respectively.

This scoring model stratified the risk of PEP in individual ERCP cases with intact papilla fairly well.