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Clinical prediction rule to determine the need for repeat ERCP after endoscopic treatment of postsurgical bile leaks
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. Univ Calgary, Dept Med, Cumming Sch Med, Calgary, AB, Canada.
Univ Calgary, Dept Med, Cumming Sch Med, Calgary, AB, Canada.;Univ Ottawa, Dept Med, Ottawa, ON, Canada..
Univ Calgary, Dept Med, Cumming Sch Med, Calgary, AB, Canada.;Univ Calgary, Cumming Sch Med, Dept Community Hlth Sci, Calgary, AB, Canada..
Univ Calgary, Dept Med, Cumming Sch Med, Calgary, AB, Canada.;Univ Calgary, Cumming Sch Med, Dept Community Hlth Sci, Calgary, AB, Canada..
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2017 (English)In: Gastrointestinal Endoscopy, ISSN 0016-5107, E-ISSN 1097-6779, Vol. 85, no 5, p. 1047-1056Article in journal (Refereed) Published
Abstract [en]

Background and Aims: In patients who have undergone ERCP with biliary stenting for postsurgical bile leaks, the optimal method (ERCP or gastroscopy) and timing of stent removal is controversial. We developed a clinical prediction rule to identify cases in which a repeat ERCP is unnecessary.

Methods: Population-based study of all patients who underwent ERCP for management of surgically induced bile leaks between 2000 and 2012. Multivariate and binary recursive partitioning analyses were performed to generate a rule predicting the absence of biliary pathology on repeat endoscopic evaluation.

Results: A total of 259 patients were included. On multivariate analysis, postsurgical normal alkaline phosphatase (ALP; OR, 2.26; 95% CI, 1.03-4.99), time from surgery to first ERCP < 8 days (OR, 2.47; 95% CI, 1.15-5.31), and minor leak with no other pathology on initial ERCP (OR, 6.74; 95% CI, 1.75-25.89) were independently associated with the absence of persistent bile leak and other pathology on repeat ERCP. The derived rule included laparoscopic cholecystectomy, normal postsurgical ALP, minor leak with no other pathology on initial ERCP, and an interval from initial to repeat ERCP between 4 and 8 weeks. When all 4 criteria were met, the rule had a sensitivity of 94% (95% CI, 83%-99%) and a negative predictive value of 93% (95% CI, 81%-99%). Optimism-adjusted sensitivity and negative predictive value were 88% (95% CI, 76%-96%) and 86% (95% CI, 73%-96%), respectively.

Conclusions: This clinical decision rule identifies patients who can have their biliary stents removed via gastroscopy, which may improve patient safety and healthcare utilization.

Place, publisher, year, edition, pages
MOSBY-ELSEVIER , 2017. Vol. 85, no 5, p. 1047-1056
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Medical and Health Sciences
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URN: urn:nbn:se:uu:diva-324623DOI: 10.1016/j.gie.2016.10.027ISI: 000401112700026PubMedID: 27810250OAI: oai:DiVA.org:uu-324623DiVA, id: diva2:1111901
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Swedish Society of MedicineAvailable from: 2017-06-19 Created: 2017-06-19 Last updated: 2017-06-19Bibliographically approved

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