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PREDICTED PROGNOSIS USING THE BALTHAZAR SCORE IS BETTER THAN EXPECTED FOR ACUTE PANCREATITIS POST ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY
W Afif, A Shingina, A Barkun
Post endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) can be a severe complication that occurs in approximately 5-7 % of patients. The computerized tomography (CT) based Balthazar score has been previously validated in predicting overall prognosis and the development of complications after an acute pancreatitis from any cause, but not specifically validated in PEP patients.
The objective of this retrospective chart review was to assess the severity of PEP using the Balthazar score and determine whether it is an accurate measure of overall prognosis, compared to published data.
Out of 3323 cases performed by one gastroenterologist at a single institution from 1990 to 2006, clinical/biochemical post ERCP pancreatitis occurred in 118 patients (3.5%), with 30 patients undergoing a CT scan to assess the degree of the pancreatitis at the host institution. 18 patients (60%) had mild pancreatitis defined as Balthazar grade A, B or C and 12 patients had more severe pancreatitis defined as Balthazar Grade D or E. In those patients with severe pancreatitis, only one patient (12%, 95% CI 6.4-17.6%) developed necrosis. This incidence is significantly lower than that reported in previous studies, which include all causes of pancreatitis, with necrosis seen in about 40 % of patients. As well, there was no mortality in patients with Grade D or E pancreatitis and their average length of stay (15 days) was shorter than expected given the severity of the pancreatitis on CT scan.
Compared with previously published data on all cause pancreatitis, patients with severe PEP, as defined by the Balthazar score, have less necrosis, shorter length of stay and less mortality. Hence the predicted overall prognosis of patients with severe PEP, based on the Balthazar score, is better than expected and can likely be attributed to the fact that these patients rarely develop necrosis. As a next step, to better assess the prognostic utility of the Balthazar score in patients with PEP, we will be performing a case-control trial.