Endoscopic retrograde cholangiopancreatography discharge tool combined with rapid trypsinogen-2 test to predict same-day discharge: a prospective cohort study.

Abstract

Objectives: Identifying patients at high-risk for endoscopic retrograde cholangiopancreatography (ERCP)-related adverse events (AEs) is important for postendoscopic discharge management. This study assesses two strategies, a urinary trypsinogen-2 (UT-2) dipstick combined with a risk-factor-based ERCP discharge tool, for identifying patients at increased risk of developing AEs.

Methods: Between August 2018 and March 2021, 268 patients were enrolled in a multicenter prospective cohort. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the UT-2 dipstick, the discharge tool, and combined strategies were assessed for predicting ERCP-related AEs.

Results: Twenty-four (10.5%) AEs occurred in the eligible 228 patients, of which 14 (6.1%) were post-ERCP pancreatitis. The discharge tool and UT-2 dipstick combination outperformed the individual strategies for all AEs with a sensitivity of 66.7% (95% CI, 44.7-84.4%), specificity of 78.5% (95% CI, 72.2-83.9%), PPV of 26.6% (95% CI, 19.8-34.8%) and NPV of 95.3% (95% CI, 91.9-97.3%). For post-ERCP pancreatitis alone, the strategies combined had a sensitivity of 64.3% (95% CI, 35.1-87.2%), specificity of 76.2% (95% CI, 69.9-81.7%), PPV of 14.9% (95% CI, 10.0-21.7%) and NPV of 97.0% (95% CI, 94.2-98.5%).

Conclusion: Although the combination of UT-2 dipstick and discharge tool outperforms the two strategies separately in predicting post-ERCP AEs, we would not recommend implementation of either strategy given the low sensitivity when applied separately or combined.