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.

Graphical abstract

中文翻译：

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预测胆管漏患者 ERCP 成功率的列线图：一项多中心研究

背景

胆管漏（BDL）是肝胆手术和创伤后发生的严重并发症，导致临床迅速恶化。内镜逆行胰胆管造影 (ERCP) 是 BDL 的一线治疗方法，但尚不清楚哪些患者会对这种治疗产生反应以及哪些患者需要额外的手术干预。我们研究的目的是探索 BDL 成功 ERCP 的预测因素。

方法

使用六个中心数据库的数据进行回顾性分析。所有临床确诊为 BDL 的连续患者均纳入该研究。收集的数据包括人口统计、疾病严重程度和 ERCP 手术特征。采用单变量和多变量分析选择影响BDL ERCP结果的独立预测因素，并建立列线图。校准和 ROC 曲线用于评估模型。

结果

448 名连续患者被临床证实为 BDL，347 名患者被排除。在纳入的101名患者中，78名患者（77.2%）取得了临床成功。在逻辑多变量回归中，两个独立因素与 ERCP 的成功呈负相关：SIRS（OR，0.183；95% CI 0.039-0.864；P  = 0.032）和高级别漏（OR 0.073；95% CI 0.010-0.539；P = 0.032）。P  = 0.010）。两个独立因素与 ERCP 的成功呈正相关：漏桥引流（OR 4.792；95% CI 1.08-21.21；P  = 0.039）和胆囊管漏（OR 6.193；95% CI 1.03-37.17；P  = 0.046） 。使用接受者操作特征 (ROC) 曲线评估包含这四个因素的预测模型，该曲线显示曲线下面积为 0.9351。校准曲线表明该模型具有良好的预测精度。

结论

漏桥引流和胆囊管漏是 ERCP 成功的阳性预测因子，而 SIRS 和高级别漏是阴性预测因子。该列线图预测模型具有良好的预测能力和临床实用价值，有助于临床决策和预测。

图形概要