The Effect of Medication on the Risk of Post-ERCP Pancreatitis
Bibliographic record
Abstract
Purpose: Pancreatitis remains the most common and significant complication of ERCP. Previous observational studies have suggested a protective effect from various medications. We set out to determine the risk of post-ERCP pancreatitis in patients using unfractionated heparin (UFH), low molecular weight heparin (LMWH), non-steroidal anti-inflammatory drugs (NSAIDs), nitrates and statins. Methods: A database of all inpatient ERCPs performed by one therapeutic endoscopist that has been compiled prospectively was retrospectively reviewed from July 2000 to November 2008. The endoscopic and patient outcomes had been recorded prospectively. Medication exposure was determined by reviewing the electronic file for each patient. Exposure to the medications of interest within one week prior to the procedure was recorded. The rates of pancreatitis were compared between the different groups using chi-squared analysis. Logistic regression analysis was used to identify risk factors for the outcome of pancreatitis. Each medication was considered separately. When a patient was on more than one medication of interest, the interaction of the medications was analysed. We used SPSS (version 17.0) to perform the statistical analysis. A p-value of <0.05 was considered statistically significant. Results: A total of 494 patients were included in this study. The mean age of the patients was 59 +- 19.75. 46.8% were male. The overall rate of pancreatitis was 5.9%; 5.2% in males and 6.5% in females. One hundred and forty four patients received UFH, 13 received LMWH, 24 received NSAIDs, 26 received nitrates and 46 received statins within one week of the procedure. In univariate evidence, pancreatic filling with contrast medium was associated with an increased rate of pancreatitis: 2.4% in patients with no pancreatic filling and 11.2% in patients with any degree of filling, p<0.001. Logistic regression found age and pancreatic filling to be risk factors for the occurrence of pancreatitis (OR=0.98; p=0.041 and OR=5.12; p<0.001, respectively). UHF and NSAIDs usage showed nonsignificant trends towards reduction in the rate of pancreatitis OR=0.685; p=0.38 and OR=0.580; p=0.35, respectively. LMWH, nitrates, statins and the different combinations of the above medications did not show any significant effect. Conclusion: Although there was a non-significant trend toward benefit in patients exposed to unfractionated heparin and NSAIDs, these results suggest that the medications of interest are not effective for prevention of pancreatitis post-ERCP.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".