Prognostic Scores In Post-Endoscopic Retrograde Cholangiopancreatography Acute Pancreatitis: Is There A Better Option?

Aims Acute pancreatitis (AP) is the most commonly observed complication after endoscopic retrograde cholangiopancreatography (ERCP). Precocious risk stratification is crucial in the management of these patients, in order to avoid adverse outcomes. Multiple prognostic scores are already commonly used in AP, regardless of its etiology. Scarce data is available upon their use specifically on post-ERCP AP. We aimed to compare the acuity of different prognostic scores at post-ERCP AP diagnosis for prediction of a moderate to severe course.

Methods We analyzed every ERCP performed in our center between January 2010 and June 2020. Patients with AP diagnosed previously to the ERCP were excluded. Final sample included patients with post-ERCP AP criteria, with the respective severity graded according to Atlanta classification. For each patient, different prognostic scores were calculated: Acute Physiology and Chronic Health Evaluation (APACHE II), Marshall, Balthazar, Glasgow-Imrie, Bedside Index for Severity of Acute Pancreatitis (BISAP), Harmless Acute Pancreatitis Score (HAPS), PANC3 and Ranson’s criteria upon admission. Each score acuity for prediction of a moderate to severe course was analyzed.

Results From a total of 2012 ERCPs, 102 (5.1 %) were complicated by AP. From these, 34 (1.7 % of all ERCPs) were classified as moderate to severe according to Atlanta classification. The scores with best acuity upon predicting a moderate to severe course were the BISAP (AUC=0.92; p<0.01), Glasgow-Imrie (AUC=0.909; p<0.01) and Balthazar (AUC=0.9; p<0.01) scores, with excellent acuity. PANC3 (AUC=0.807; p<0.01), APACHE II (AUC=0.809; p<0.01) and Marshall score (AUC=0.778; p<0.01) revealed good acuity. HAPS classification (AUC=0.671; p<0.01) and Ranson’s criteria upon admission (AUC=0.647; p<0.01) presented less accurate results.

Conclusions BISAP, Glasgow-Imrie and Balthazar classifications presented excellent acuities upon predicting moderate to severe post-ERCP AP, and must represent the most useful prognostic scores for risk stratification in this population.

Citation Macedo Silva V, Freitas M, Sousa Magalhães R et al. eP342 PROGNOSTIC SCORES IN POST-ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY ACUTE PANCREATITIS: IS THERE A BETTER OPTION? Endoscopy 2021; 53: S209.

Publication History

Article published online:
19 March 2021