Risk Factors and Development of a Risk Score Model for Acute Pain After ERCP in Patients with Choledocholithiasis.
- 1The Centre of Gallbladder Diseases, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200120, People's Republic of China.
- 2Department of Hepatobiliary and Pancreatic Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200120, People's Republic of China.
- 3Department of Anesthesiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200120, People's Republic of China.
Abstract
Purpose
Acute pain following endoscopic retrograde cholangiopancreatography (ERCP) in patients with choledocholithiasis is common but remains insufficiently characterized. Most existing prediction models primarily emphasize procedural variables, with limited consideration of psychological factors. This study aimed to identify risk factors for post-ERCP acute pain and to develop a clinically applicable risk scoring model for early postoperative risk stratification.Patients and methods
This prospective observational cohort study at a tertiary hospital (January 2024-December 2025) enrolled consecutive patients undergoing ERCP for choledocholithiasis. Pain intensity was assessed using the Numeric Rating Scale (NRS) at 2, 8, and 24 hours post-procedure; the highest score across these time points was defined as peak postoperative pain, and NRS ≥ 4 was classified as moderate-to-severe pain. Preoperative anxiety (Self-Rating Anxiety Scale, SAS) and Type A behavior (Type A Behavior Pattern Scale, TABP) were evaluated. Independent predictors were identified using multivariable logistic regression, and a risk score was developed with internal validation via bootstrap resampling (1,000 iterations) and decision curve analysis (DCA).Results
Among 340 patients (mean age 58.4 ± 12.6 years; 53.5% male), 162 (47.6%) developed moderate-to-severe pain. Six independent predictors were identified: procedural duration > 45 minutes (OR = 2.12), stone diameter > 15 mm (OR = 2.24), postoperative 6-hour C-reactive protein (CRP) > 50 mg/L (OR = 1.83), preoperative anxiety (SAS ≥ 60; OR = 2.56), Type A behavior (TABP ≥ 37; OR = 1.80), and body mass index (BMI) ≥ 28 kg/m² (OR = 1.68). A significant interaction between anxiety and Type A behavior was observed (P = 0.009). The risk score ranged from 0 to 9 points and showed good discrimination (area under the curve [AUC] = 0.808; optimism-corrected AUC = 0.802) and acceptable calibration (Hosmer-Lemeshow P = 0.223). DCA demonstrated net clinical benefit across threshold probabilities of 15%-70%.Conclusion
This internally validated model, integrating preoperative, procedural, and early postoperative factors, may facilitate early post-procedure risk stratification and support timely risk-adapted monitoring and management. External validation is required before clinical application.
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BibTeX
@article{sun2026risk,
title = {{Risk Factors and Development of a Risk Score Model for Acute Pain After ERCP in Patients with Choledocholithiasis.}},
author = {Shanshan Sun and Yongmei You and Xia Wang and Qian Cao and Xujing Chen and Hui Li and Xingchen Hu and Lili Ma and Huiren Zhuang},
journal = {Journal of pain research},
year = {2026},
month = oct,
doi = {10.2147/jpr.s630313},
url = {https://europepmc.org/article/MED/42974466},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Risk Factors and Development of a Risk Score Model for Acute Pain After ERCP in Patients with Choledocholithiasis.
AU - Shanshan Sun
AU - Yongmei You
AU - Xia Wang
AU - Qian Cao
AU - Xujing Chen
AU - Hui Li
AU - Xingchen Hu
AU - Lili Ma
AU - Huiren Zhuang
PY - 2026
DA - 2026/10/29
JO - Journal of pain research
DO - 10.2147/jpr.s630313
UR - https://europepmc.org/article/MED/42974466
AB - Purpose Acute pain following endoscopic retrograde cholangiopancreatography (ERCP) in patients with choledocholithiasis is common but remains insufficiently characterized. Most existing prediction models primarily emphasize procedural variables, with limited consideration of psychological factors. This study aimed to identify risk factors for post-ERCP acute pain and to develop a clinically applicable risk scoring model for early postoperative risk stratification.Patients and methods This prospective observational cohort study at a tertiary hospital (January 2024-December 2025) enrolled consecutive patients undergoing ERCP for choledocholithiasis. Pain intensity was assessed using the Numeric Rating Scale (NRS) at 2, 8, and 24 hours post-procedure; the highest score across these time points was defined as peak postoperative pain, and NRS ≥ 4 was classified as moderate-to-severe pain. Preoperative anxiety (Self-Rating Anxiety Scale, SAS) and Type A behavior (Type A Behavior Pattern Scale, TABP) were evaluated. Independent predictors were identified using multivariable logistic regression, and a risk score was developed with internal validation via bootstrap resampling (1,000 iterations) and decision curve analysis (DCA).Results Among 340 patients (mean age 58.4 ± 12.6 years; 53.5% male), 162 (47.6%) developed moderate-to-severe pain. Six independent predictors were identified: procedural duration > 45 minutes (OR = 2.12), stone diameter > 15 mm (OR = 2.24), postoperative 6-hour C-reactive protein (CRP) > 50 mg/L (OR = 1.83), preoperative anxiety (SAS ≥ 60; OR = 2.56), Type A behavior (TABP ≥ 37; OR = 1.80), and body mass index (BMI) ≥ 28 kg/m² (OR = 1.68). A significant interaction between anxiety and Type A behavior was observed (P = 0.009). The risk score ranged from 0 to 9 points and showed good discrimination (area under the curve [AUC] = 0.808; optimism-corrected AUC = 0.802) and acceptable calibration (Hosmer-Lemeshow P = 0.223). DCA demonstrated net clinical benefit across threshold probabilities of 15%-70%.Conclusion This internally validated model, integrating preoperative, procedural, and early postoperative factors, may facilitate early post-procedure risk stratification and support timely risk-adapted monitoring and management. External validation is required before clinical application.
SN - 1178-7090
ER -