Prophylaxis of post-ERCP pancreatitis: a practice survey

Dumonceau, Jean-Marc; Rigaux, Johanne; Kahaleh, Michel; Gomez, Carlos Macias; Vandermeeren, Alain; Devière, Jacques

doi:10.1016/j.gie.2009.10.055

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Volume 71, Issue 6 , Pages 934-939.e2, May 2010

Prophylaxis of post-ERCP pancreatitis: a practice survey

Current affiliations: Division of Gastroenterology and Hepatology (J.-M.D.), Geneva University Hospitals, Geneva, Switzerland, Medical-Surgical Department of Gastroenterology and Hepatopancreatology (J.R., A.V., J.D.), Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium, Digestive Health Centre (M.K.), University of Virginia Health System, Charlottesville, Virginia, USA, Gastrointestinal Endoscopy Unit (C.M.G.), Gastroenterology Service, Italian Hospital, Buenos Aires, Argentina

Received 19 August 2009; accepted 20 October 2009. published online 12 March 2010.

Background

Prophylactic pancreatic stenting is widely used by expert biliary endoscopists to prevent post-ERCP pancreatitis (PEP); nonsteroidal anti-inflammatory drugs (NSAIDs) are thought to prevent PEP.

Objective

To assess the use of pancreatic stenting and NSAIDs for PEP prophylaxis among endoscopists and its determinants.

Design

A survey was distributed to 467 endoscopists attending a course on therapeutic digestive endoscopy.

Intervention

Completed surveys were collected from 141 endoscopists performing ERCP in 29 countries (answer rate 30.2%); practices were most often located in community hospitals with an annual hospital volume of ≤500 ERCPs (in Belgium, Spain, Italy, and France in about half of cases). For all conditions listed, including needle-knife precut, previous PEP, suspected sphincter of Oddi dysfunction, and ampullectomy, less than half of the endoscopists reported attempting prophylactic pancreatic stenting in ≥75% of cases. Thirty (21.3%) survey respondents did not perform prophylactic pancreatic stenting in any circumstance; this was mainly ascribed to lack of experience. Measurement of PEP incidence and an annual hospital volume of >500 ERCPs were independently associated with the use of prophylactic pancreatic stenting (P = .005 and P = .030, respectively). Most survey respondents (n = 118, 83.7%) did not use NSAIDs for PEP prophylaxis. This was mainly ascribed to lack of scientific evidence of its benefits.

Main Outcome Measurements

Proportion of cases in which pancreatic stenting is attempted during ERCP; reasons for not using prophylactic pancreatic stenting or NSAIDs.

Limitations

Survey, not an audit of practice.

Conclusions

Despite scientific evidence of its benefits, use of prophylactic pancreatic stenting is not as widely adopted as previously thought; use of NSAIDs for PEP prophylaxis is marginal.

Abbreviations: NSAIDs, nonsteroidal anti-inflammatory drugs, PEP, post-ERCP pancreatitis, SOD, sphincter of Oddi dysfunction