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- Title
A nomogram for prediction of ERCP success in patients with bile duct leaks: a multicenter study.
- Authors
Chen, De-xin; Chen, Sheng-xin; Hou, Sen-lin; Wen, Gui-hai; Yang, Hai-kun; Shi, Da-peng; Lu, Qing-xin; Zhai, Ya-qi; Li, Ming-yang
- Abstract
Background: Bile duct leaks (BDLs) are serious complications that occurs after hepatobiliary surgery and trauma, leading to rapid clinical deterioration. Endoscopic retrograde cholangiopancreatography (ERCP) is the first-line treatment for BDLs, but it is not clear which patients will respond to this therapy and which patients will require additional surgical intervention. The aim of our study was to explore the predictors of successful ERCP for BDLs. Methods: A retrospective analysis was conducted using data from six centers' databases. All consecutive patients who were clinically confirmed as BDLs were included in the study. Collected data were demographics, disease severity, and ERCP procedure characteristics. Univariate and multivariate analysis were used to select independent predictive factors that affect the outcome of ERCP for BDLs, and a nomogram was established. Calibration and ROC curves were used to evaluate the models. Results: Four hundred and forty-eight consecutive patients were clinically confirmed as BDLs and 347 were excluded. In the 101 patients included patients, clinical success was achieved in 78 patients (77.2%). In logistic multivariable regression, two independent factors were negatively associated with the success of ERCP: SIRS (OR, 0.183; 95% CI 0.039–0.864; P = 0.032) and high-grade leak (OR 0.073; 95% CI 0.010–0.539; P = 0.010). Two independent factors were positively associated with the success of ERCP: leak-bridging drainage (OR 4.792; 95% CI 1.08–21.21; P = 0.039) and cystic duct leak (OR 6.193; 95% CI 1.03–37.17; P = 0.046). The prediction model with these four factors was evaluated using a receiver-operating characteristic (ROC) curve, which demonstrated an area under the curve of 0.9351. The calibration curve showed that the model had good predictive accuracy. Conclusion: Leak-bridging drainage and cystic duct leak are positive predictors for the success of ERCP, while SIRS and high-grade leak are negative predictors. This prediction model with nomogram has good predictive ability and practical clinical value, and may be helpful in clinical decision-making and prognostication.
- Subjects
BILE duct surgery; LIVER surgery; STATISTICAL models; PREDICTION models; RECEIVER operating characteristic curves; T-test (Statistics); MULTIPLE regression analysis; FISHER exact test; BILE duct diseases; TREATMENT effectiveness; RETROSPECTIVE studies; SEVERITY of illness index; MULTIVARIATE analysis; DECISION making in clinical medicine; DESCRIPTIVE statistics; MANN Whitney U Test; CHI-squared test; SURGICAL complications; ODDS ratio; RESEARCH; STATISTICS; CALIBRATION; CONFIDENCE intervals; DATA analysis software; ENDOSCOPIC retrograde cholangiopancreatography; PREDICTIVE validity; EVALUATION
- Publication
Surgical Endoscopy & Other Interventional Techniques, 2024, Vol 38, Issue 5, p2465
- ISSN
1866-6817
- Publication type
Article
- DOI
10.1007/s00464-024-10734-w