Euroasian Journal of Hepato-Gastroenterology

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VOLUME 12 , ISSUE 1 ( January-June, 2022 ) > List of Articles

Original Article

Role of “HinCh Score” as a Non-invasive Predictor of Post-endoscopic Retrograde Cholangiopancreatography Cholangitis

Hina Ismail, Muhammad Danish, Farina Hanif, Farrah Hanif, Arshad Jariko, Zain Majid

Keywords : Endoscopic retrograde cholangiopancreatography, HinCh score, Post-ERCP cholangitis

Citation Information : Ismail H, Danish M, Hanif F, Hanif F, Jariko A, Majid Z. Role of “HinCh Score” as a Non-invasive Predictor of Post-endoscopic Retrograde Cholangiopancreatography Cholangitis. Euroasian J Hepatogastroenterol 2022; 12 (1):19-23.

DOI: 10.5005/jp-journals-10018-1373

License: CC BY-NC 4.0

Published Online: 13-07-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Introduction: Post-endoscopic retrograde cholangiopancreatography (ERCP) cholangitis (PEC) is associated with increased morbidity and mortality in patients ERCP. The aim of the present study was to analyze the predictors of PEC and to formulate a predictive model for early diagnosis and management. Materials and methods: It was a cross-sectional study that was carried out at the Sindh Institute of Urology and Transplantation from September 2019 to June 2021. All patients aged between 18 and 75 years and undergoing ERCP due to obstructive jaundice were included. Patients with altered biliary anatomy, history of hepatobiliary surgery, and concurrent sepsis were excluded. Endoscopic retrograde cholangiopancreatography intervention was performed by an expert gastroenterologist. Laboratory parameters (total leukocyte count, total bilirubin, alanine transaminase) and patient temperature were checked on admission, at 12 hours, 24 hours, and 36 hours after ERCP to document PEC. Results: A total of 349 patients were included in the study. Among them, 176 (50.4%) patients were males. Common bile duct (CBD) stricture was the most common indication of ERCP seen in 148 (42.4%) patients followed by CBD stone and cholangiocarcinoma in 108 (30.9%) and 48 (13.8%) patients, respectively. The most common presenting complaint was jaundice noted in 300 (86%) patients followed by right hypochondrial pain in 280 (80.2%) and weight loss in 194 (55.6%) patients, respectively. Post-ERCP cholangitis developed in 251 (71.9%) patients. On univariate analysis, age >50 years, female gender, right hypochondrial pain, fever, bilirubin >5 mg/dL on admission, CBD stricture on ERCP, TLC of >10,000 cells/L at 12 hours, 24 hours, and 36 hours post-ERCP and rise in ALT >50 IU 24 and 48 hours post-ERCP were significantly associated with PEC. While on multivariate analysis, female gender, bilirubin >5 mg/dL on admission, CBD stricture on ERCP, post-ERCP fever, and rise in TLC of > 10000 cells/L at 24 hours post-ERCP were independently associated with PEC. HinCh score was formulated and was found to be significantly associated with the presence of cholangitis. Area under the receiver operating characteristics (AUROC) of HinCh score was 0.74 and at cutoff of ≥4, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of HinCh were 81.67%, 59.18%, 83.67%, and 55.71%, respectively with a diagnostic accuracy of 75.36%. Conclusion: The performance of HinCh score in predicting PEC was accurate in 86% of the patients. However, further studies are needed to validate the score.

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  1. ASGE Standards of Practice Committee; Maple JT, Ben-Menachem T, et al. The role of endoscopy in the evaluation of suspected choledocholithiasis. Gastrointest Endosc 2010;71(1):1–9. DOI: 10.1016/j.gie.2009.09.041.
  2. Katsinelos P, Lazaraki G, Chatzimavroudis G, et al. Risk factors for therapeutic ERCP-related complications: an analysis of 2,715 cases performed by a single endoscopist. Ann Gastroenterol 2014;27(1):65. PMID: 24714755.
  3. Ertuğrul I, Yüksel I, Parlak E, et al. Risk factors for endoscopic retrograde cholangiopancreatography-related cholangitis: a prospective study. Turk J Gastroenterol 2009;20(2):116–121. PMID: 19530044.
  4. Tan M, de Muckadell OB, Laursen SB. Association between early ERCP and mortality in patients with acute cholangitis. Gastrointest Endosc 2018;87(1):185–192. DOI: 10.1016/j.gie.2017.04.009.
  5. Chen M, Wang L, Wang Y, et al. Risk factor analysis of post-ERCP cholangitis: a single-center experience. Hepatobiliary Pancreat Dis Int 2018;17(1):55–58. DOI: 10.1016/j.hbpd.2018.01.002.
  6. Tierney J, Bhutiani N, Stamp B, et al. Predictive risk factors associated with cholangitis following ERCP. Surg Endosc 2018;32(2):799–804. DOI: 10.1007/s00464-017-5746-z.
  7. Nayab D, Akhtar SA, Rehman S, et al. Frequency of early post-ERCP adverse events in both diagnostic and therapeutic procedures. Gomal J Med Sci 2018;16(2). DOI: 10.46903/gjms/16.02.1935.
  8. Vandervoort J, Soetikno RM, Tham TCK, et al. Risk factors for complications after performance of ERCP. Gastrointest Endosc 2002;56(5):652–656. DOI: 10.1067/mge.2002.129086.
  9. Kiriyama S, Kozaka K, Takada T, et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos). J Hepatobiliary Pancreat Sci 2018;25(1):17–30. DOI: 10.1002/jhbp.512.
  10. Kwak MS, Jang ES, Ryu JK, et al. Risk factors of post endoscopic retrograde cholangiopancreatography bacteremia. Gut Liver 2013;7(2):228–233. DOI: 10.5009/gnl.2013.7.2.228.
  11. Du M, Suo J, Liu B, et al. Post-ERCP infection and its epidemiological and clinical characteristics in a large Chinese tertiary hospital: a 4-year surveillance study. Antimicrob Resist Infect Control 2017;6:131. DOI: 10.1186/s13756-017-0290-0.
  12. Szary NM, Al-Kawas FH. Complications of endoscopic retrograde cholangiopancreatography: how to avoid and manage them. Gastroenterol Hepatol (NY) 2013;9(8):496–504. PMID: 24719597.
  13. Ishigaki T, Sasaki T, Serikawa M, et al. Evaluation of antibiotic use to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis and cholangitis. Hepatogastroenterology 2015;62(138): 417–424. PMID: 25916074.
  14. Ma MX, Jayasekeran V, Chong AK. Benign biliary strictures: prevalence, impact, and management strategies. Clin Exp Gastroenterol 2019; 12:83–92. DOI: 10.2147/CEG.S165016.
  15. Zuleta MG, Melgar C, Arbeláez V. Does age influence complications of endoscopic retrograde cholangiopancreatography (ERCP)? Rev Col Gastroenterol 2010;25(4):349–353.
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