{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T12:23:13Z","timestamp":1774527793952,"version":"3.50.1"},"reference-count":26,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2021,2,20]],"date-time":"2021-02-20T00:00:00Z","timestamp":1613779200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathophysiology"],"abstract":"<jats:p>Background. Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) remains common, and severe complications are associated with ERCP. There is no previous study detailing the effect of race and gender in a US-based population on risk of PEP. Methods. Data were collected on 269 \u201cfirst-performed\u201d consecutive ERCPs followed by division by race (White vs. African-American) and sex (Female vs. Male). A total of 53 probable risk factors were evaluated by uni- and multivariate analysis followed by outcomes expressed as an odds ratio (OR) (with a 95% confidence interval, 95% CI). Finally, a principal component analysis was performed to construct a risk prediction model for PEP, which can be used by clinicians at bedside. Results. After analyzing the risk factors based on race and gender-based groups, Caucasian males with PEP are more likely to have prior history of pancreatitis (p = 0.009), lower hemoglobin (p = 0.02)\/blood urea nitrogen (BUN) (p = 0.01)\/creatinine before ERCP (p = 0.07) and lower BUN (p = 0.01)\/creatinine after ERCP (p = 0.07), while Caucasian females with PEP are more likely to have higher white blood cell (WBC) count before ERCP (p = 0.08) and lower amylase (p = 0.10)\/bilirubin (p = 0.09)\/aspartate aminotransferase (AST) after ERCP (p = 0.08). African-American males with PEP are more likely to have lower weight (p = 0.001)\/smaller height (p = 0.0005)\/lower alkaline phosphatase (p = 0.002)\/AST (p = 0.04)\/alanine transaminase (ALT) (p = 0.03) before ERCP and lower alkaline phosphatase (p = 0.002)\/AST (p = 0.01)\/ALT (p = 0.004) after ERCP, while African-American females with PEP are more likely to have prior history of pancreatitis (p = 0.004)\/higher lipase before (p = 0.0001) and after (p = 0.05) ERCP along with increased risk with pancreatic duct cannulation (p = 0.0001) and injection (p = 0.0001)\/biliary sphincterotomy (p = 0.0001). Importantly, prior history of ERCP, elevated AST after ERCP, and BUN prior to ERCP were found to be important clinical features predicting post-ERCP pancreatitis. To our knowledge, this is a first known attempt at developing a risk scoring system for PEP in a US population with decision tree learning. Conclusions. It is very evident that both patient and procedure-related risk factors vary by race and gender in the US population, leading to the development of a new risk assessment tool for PEP that can be used in clinical practice. We need to follow up with a larger prospective study to validate this novel race and gender-based risk scoring system for PEP.<\/jats:p>","DOI":"10.3390\/pathophysiology28010007","type":"journal-article","created":{"date-parts":[[2021,2,21]],"date-time":"2021-02-21T23:59:31Z","timestamp":1613951971000},"page":"76-85","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Risk Stratification in Post-ERCP Pancreatitis: How Do Procedures, Patient Characteristics and Clinical Indicators Influence Outcomes?"],"prefix":"10.3390","volume":"28","author":[{"given":"Kapil","family":"Kohli","sequence":"first","affiliation":[{"name":"Departments of Medicine\/Section of Gastroenterology and Hepatology, Ochsner-LSU Health Sciences Center in Shreveport, Shreveport, LA 71103-3932, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hrishikesh","family":"Samant","sequence":"additional","affiliation":[{"name":"Departments of Medicine\/Section of Gastroenterology and Hepatology, Ochsner-LSU Health Sciences Center in Shreveport, Shreveport, LA 71103-3932, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kashif","family":"Khan","sequence":"additional","affiliation":[{"name":"Departments of Medicine\/Section of Gastroenterology and Hepatology, Ochsner-LSU Health Sciences Center in Shreveport, Shreveport, LA 71103-3932, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sudha","family":"Pandit","sequence":"additional","affiliation":[{"name":"Departments of Medicine\/Section of Gastroenterology and Hepatology, Ochsner-LSU Health Sciences Center in Shreveport, Shreveport, LA 71103-3932, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelli","family":"Morgan","sequence":"additional","affiliation":[{"name":"Departments of Medicine\/Section of Gastroenterology and Hepatology, Ochsner-LSU Health Sciences Center in Shreveport, Shreveport, LA 71103-3932, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2042-6415","authenticated-orcid":false,"given":"Urska","family":"Cvek","sequence":"additional","affiliation":[{"name":"Department of Computer Sciences, Louisiana State University-Shreveport, Shreveport, LA 71115, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Phillip","family":"Kilgore","sequence":"additional","affiliation":[{"name":"Department of Computer Sciences, Louisiana State University-Shreveport, Shreveport, LA 71115, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marjan","family":"Trutschl","sequence":"additional","affiliation":[{"name":"Department of Computer Sciences, Louisiana State University-Shreveport, Shreveport, LA 71115, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eleni","family":"Mijalis","sequence":"additional","affiliation":[{"name":"Departments of Medicine\/Section of Gastroenterology and Hepatology, Ochsner-LSU Health Sciences Center in Shreveport, Shreveport, LA 71103-3932, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Jordan","sequence":"additional","affiliation":[{"name":"Departments of Medicine\/Section of Gastroenterology and Hepatology, Ochsner-LSU Health Sciences Center in Shreveport, Shreveport, LA 71103-3932, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Morris","sequence":"additional","affiliation":[{"name":"Departments of Medicine\/Section of Gastroenterology and Hepatology, Ochsner-LSU Health Sciences Center in Shreveport, Shreveport, LA 71103-3932, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Moheb","family":"Boktor","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6975-3711","authenticated-orcid":false,"given":"Jonathan Steven","family":"Alexander","sequence":"additional","affiliation":[{"name":"Departments of Medicine\/Section of Gastroenterology and Hepatology, Ochsner-LSU Health Sciences Center in Shreveport, Shreveport, LA 71103-3932, USA"},{"name":"Department of Molecular and Cellular Physiology, Louisiana State University, 1501 Kings Highway, Shreveport, LA 71103-3932, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,2,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.gie.2016.06.051","article-title":"Adverse events associated with ERCP","volume":"85","author":"Chandrasekhara","year":"2017","journal-title":"Gastrointest. Endosc."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1111\/j.1572-0241.2006.00380.x","article-title":"Risk factors for post-ERCP pancreatitis: A prospective multicenter study","volume":"101","author":"Ismail","year":"2006","journal-title":"Am. J. Gastroenterol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1016\/S0016-5107(99)70386-X","article-title":"Features that may predict hospital admission following outpatient therapeutic ERCP","volume":"49","author":"Ho","year":"1999","journal-title":"Gastrointest. Endosc."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/S0016-5107(98)70121-X","article-title":"Major early complications from diagnostic and therapeutic ERCP: A prospective multicenter study","volume":"48","author":"Loperfido","year":"1998","journal-title":"Gastrointest. Endosc."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1056\/NEJM199609263351301","article-title":"Complications of endoscopic biliary sphincterotomy","volume":"335","author":"Freeman","year":"1996","journal-title":"N. Engl. J. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1055\/s-2000-138","article-title":"Analysis of the risk factors associated with endoscopic sphincterotomy techniques: Preliminary results of a prospective study, with emphasis on the reduced risk of acute pancreatitis with low-dose anticoagulation treatment","volume":"32","author":"Rabenstein","year":"2000","journal-title":"Endoscopy"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1111\/j.1572-0241.2001.03594.x","article-title":"Complications of diagnostic and therapeutic ERCP: A prospective multicenter study","volume":"96","author":"Masci","year":"2001","journal-title":"Am. J. Gastroenterol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1067\/mge.2001.117550","article-title":"Risk factors for post-ERCP pancreatitis: A prospective, multicenter study","volume":"54","author":"Freeman","year":"2001","journal-title":"Gastrointest. Endosc."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1016\/S0016-5107(02)70112-0","article-title":"Risk factors for complications after performance of ERCP","volume":"56","author":"Vandervoort","year":"2002","journal-title":"Gastrointest. Endosc."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1016\/S0016-5107(04)02169-8","article-title":"Complications of ERCP: A prospective study","volume":"60","author":"Christensen","year":"2004","journal-title":"Gastrointest. Endosc."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1016\/j.gie.2006.10.021","article-title":"Frequency and severity of post-ERCP pancreatitis correlated with extent of pancreatic ductal opacification","volume":"65","author":"Cheon","year":"2007","journal-title":"Gastrointest. Endosc."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1055\/s-2007-966723","article-title":"Risk factors for complication following ERCP; results of a large-scale, prospective multicenter study","volume":"39","author":"Williams","year":"2007","journal-title":"Endoscopy"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1038\/ajg.2008.5","article-title":"Risk factors for ERCP-related complications: A prospective multicenter study","volume":"104","author":"Wang","year":"2009","journal-title":"Am. J. Gastroenterol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/j.gie.2008.10.039","article-title":"Risk factors for complications after ERCP: A multivariate analysis of 11,497 procedures over 12 years","volume":"70","author":"Cotton","year":"2009","journal-title":"Gastrointest. Endosc."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1781","DOI":"10.1111\/j.1572-0241.2007.01279.x","article-title":"Incidence rates of post-ERCP complications: A systematic survey of prospective studies","volume":"102","author":"Andriulli","year":"2007","journal-title":"Am. J. Gastroenterol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1016\/j.gie.2010.07.047","article-title":"Nationwide, population-based data from 11,074 ERCP procedures from the Swedish Registry for Gallstone Surgery and ERCP","volume":"72","author":"Enochsson","year":"2010","journal-title":"Gastrointest. Endosc."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/j.gie.2014.06.045","article-title":"Incidence, severity, and mortality of post-ERCP pancreatitis: A systematic review by using randomized, controlled trials","volume":"81","author":"Kochar","year":"2015","journal-title":"Gastrointest. Endosc."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1055\/s-2002-23630","article-title":"Post-ERCP pancreatitis and hyperamylasemia: Patient-related and operative risk factors","volume":"34","author":"Christoforidis","year":"2002","journal-title":"Endoscopy"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1111\/j.1572-0241.2006.00950.x","article-title":"Pharmacotherapy for the prevention of post-ERCP pancreatitis","volume":"102","author":"Foster","year":"2007","journal-title":"Am. J. Gastroenterol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1016\/j.surge.2014.11.005","article-title":"Risk factors for post-ERCP pancreatitis: A systematic review and meta-analysis","volume":"13","author":"Ding","year":"2015","journal-title":"Surgeon"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1020","DOI":"10.1111\/imj.12844","article-title":"Protective effect of advanced age on post-ERCP pancreatitis and unplanned hospitalisation","volume":"45","author":"Neeman","year":"2015","journal-title":"Intern. Med. J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.1016\/j.gie.2015.04.032","article-title":"ERCP in elderly patients: Increased risk of sedation adverse events but low frequency of post-ERCP pancreatitis","volume":"82","author":"Finkelmeier","year":"2015","journal-title":"Gastrointest. Endosc."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1016\/j.gtc.2007.03.006","article-title":"Incidence, risk factors, and prevention of post-ERCP pancreatitis","volume":"36","author":"Cooper","year":"2007","journal-title":"Gastroenterol. Clin. N. Am."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1097\/SLE.0b013e3182901461","article-title":"Risk factors of post-ERCP pancreatitis at a tertiary referral center in Japan","volume":"24","author":"Kakutani","year":"2014","journal-title":"Surg. Laparosc. Endosc. Percutan. Tech."},{"key":"ref_25","unstructured":"Therneau, T., Atkinson, B., and Ripley, B. (2019, April 12). \u201cPackage \u2018rpart\u2019: Recursive Partitioning and Regression Trees\u201d. Available online: https:\/\/cran.r-project.org\/web\/packages\/rpart\/rpart.pdf."},{"key":"ref_26","unstructured":"Breimann, L., Friedman, J., Stone, C.J., and Olshen, R.A. (1984). Classification and Regression Trees. Wiley Interdisciplinary Reviews: Data Mining and Knowledge Discovery, Wadsworth."}],"container-title":["Pathophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1873-149X\/28\/1\/7\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:27:13Z","timestamp":1760160433000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1873-149X\/28\/1\/7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,20]]},"references-count":26,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,3]]}},"alternative-id":["pathophysiology28010007"],"URL":"https:\/\/doi.org\/10.3390\/pathophysiology28010007","relation":{},"ISSN":["1873-149X"],"issn-type":[{"value":"1873-149X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,20]]}}}