Advertisement

Practice patterns of post-ERCP pancreatitis prophylaxis techniques in the United States: a survey of advanced endoscopists

Published:November 16, 2019DOI:https://doi.org/10.1016/j.gie.2019.11.013

      Background and Aims

      The American Society for Gastrointestinal Endoscopy recommends prophylactic pancreatic duct stent placement (PPS) and rectal nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce the incidence and severity of post-ERCP pancreatitis (PEP) in high-risk individuals and suggests that rectal indomethacin may decrease the risk and severity of PEP in average-risk individuals. The European Society for Gastrointestinal Endoscopy recommends rectal indomethacin for all patients undergoing ERCP. Previous surveys of European endoscopists revealed low adoption of PPS or rectal NSAIDs to prevent PEP. We sought to capture current practice in the prevention of PEP among endoscopists in the United States involved in advanced endoscopy fellowship programs.

      Methods

      An anonymous online 16-item survey was e-mailed to 233 advanced endoscopists involved in advanced endoscopy fellowship programs.

      Results

      Of the 233 endoscopists who were invited to participate, 62 responded (26.7%). Most respondents reported working in tertiary referral centers (57; 95.0%) and performing ERCP for greater than 5 years (44; 74.6%). All respondents (60; 100.0%) reported working with fellows. Most PPS users (41; 72.0%) reported use of PPS in high-risk patients only and using PPS for PEP in ≤25% of ERCPs (38; 64.4%). Most respondents reported using rectal NSAIDs for high-risk patients only (34; 59.7%) compared with respondents (23; 40.1%) who reported using rectal NSAIDs for prevention of PEP in average-risk patients undergoing ERCP. Most respondents (49; 83.0%) also reported using rapid intravenous fluids to prevent PEP.

      Conclusions

      Among endoscopists involved in advanced endoscopy fellowships in the United States, rectal NSAIDs are used more frequently than PPS in the prevention of PEP. Despite mounting evidence supporting the use of rectal NSAIDs to prevent PEP in average-risk patients, less than half of the respondents in this survey reported such practice.

      Abbreviations:

      ASGE (American Society for Gastrointestinal Endoscopy), NSAID (nonsteroidal anti-inflammatory drug), PEP (post-ERCP pancreatitis), PPS (prophylactic pancreatic duct stent placement)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Gastrointestinal Endoscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Andriulli A.
        • Loperfido S.
        • Napolitano G.
        • et al.
        Incidence rates of post-ERCP complications: a systematic survey of prospective studies.
        Am J Gastroenterol. 2007; 102: 1781-1788
        • Testoni P.
        • Mariani A.
        • Giussani A.
        • et al.
        Risk factors for post-ERCP pancreatitis in high- and low-volume centers and among expert and non-expert operators: a prospective multicenter study.
        Am J Gastroenterol. 2010; 105: 1753-1761
        • Chandrasekhara V.
        • Khashab M.
        • Fasge V.
        • et al.
        Adverse events associated with ERCP.
        Gastrointest Endosc. 2017; 85: 32-47
        • Dumonceau J.
        • Andriulli A.
        • Elmunzer B.
        • et al.
        Prophylaxis of post-ERCP pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) guideline updated June 2014.
        Endoscopy. 2014; 46: 799-815
        • Lopes L.
        • Canena J.
        ERCP in Portugal: a wide survey on the prevention of post-ERCP pancreatitis and papillary cannulation techniques.
        Portug J Gastroenterol. 2019; 26: 14-23
        • Hanna M.
        • Portal A.
        • Dhanda A.
        • et al.
        UK wide survey on the prevention of post-ERCP pancreatitis.
        Frontline Gastroenterol. 2014; 5: 103-110
        • Dumonceau J.
        • Rigaux J.
        • Kahaleh M.
        • et al.
        Prophylaxis of post-ERCP pancreatitis: a practice survey.
        Gastrointest Endosc. 2010; 71: 934-939
        • Elmunzer B.
        • Schieman J.
        • et al.
        A randomized trial of rectal indomethacin to prevent post-ERCP pancreatitis.
        N Engl J Med. 2012; 366: 1414-1422
        • Levenick J.
        • Gordon S.
        • Fadden L.
        • et al.
        Rectal indomethacin does not prevent post-ERCP pancreatitis in consecutive patients.
        Gastroenterology. 2016; 150: 911-917
        • Luo H.
        • Zhao L.
        • Leung J.
        • et al.
        Routine pre-procedural rectal indomethacin versus selective post-procedural rectal indomethacin to prevent pancreatitis in patients undergoing endoscopic retrograde cholangiopancreatography: a multicenter, single-blinded, randomized controlled trial.
        Lancet. 2016; 387: 2293-2301
        • Thiruvengadam N.
        • Forde K.A.
        • Ma G.K.
        • et al.
        Rectal indomethacin reduces pancreatitis in high- and low-risk patients undergoing endoscopic retrograde cholangiopancreatography.
        Gastroenterology. 2016; 151: 288-297
        • Yang C.
        • Zhao Y.
        • Li W.
        • et al.
        Rectal nonsteroidal anti-inflammatory drugs administration is effective for the prevention of post-ERCP pancreatitis: an updated meta-analysis of randomized controlled trials.
        Pancreatology. 2017; 17: 681-688
        • Williams E.
        • et al.
        • Bsg Audit of ERCP Steering Committee
        Defining the difficult ERCP: performance of the ASGE (modified Schutz) scoring system in a prospectively studied cohort of 5264 procedures [Abstract].
        Gastrointest Endosc. 2006; 63: AB87
        • Singh P.
        • Das G.
        • Isenberg G.
        • et al.
        Does prophylactic pancreatic stent placement reduce the risk of post-ERCP acute pancreatitis? A meta-analysis of controlled trials.
        Gastrointest Endosc. 2004; 60: 544-550
        • Johanson J.F.
        • Cooper G.
        • Eisen G.M.
        • et al.
        Quality assessment of ERCP: Endoscopic retrograde cholangiopacreatography.
        Gastrointest Endosc. 2002; 56: 165-169
        • Ding X.
        • Chen M.
        • Huang S.
        • et al.
        Nonsteroidal anti-inflammatory drugs for prevention of post-ERCP pancreatitis: a meta-analysis.
        Gastrointest Endosc. 2012; 76: 1152-1159
        • Mazaki T.
        • Mado K.
        • Masuda H.
        • et al.
        Prophylactic pancreatic stent placement and post-ERCP pancreatitis: an updated meta-analysis.
        J Gastroenterol. 2014; 49: 343-355
        • Elmunzer B.J.
        • Serrano J.
        • Chak A.
        • et al.
        Rectal indomethacin alone versus indomethacin and prophylactic pancreatic stent placement for preventing pancreatitis after ERCP: study protocol for a randomized controlled trial.
        Trials. 2016; 17: 120
        • Boynton P.
        • Greenhalgh T.
        Selecting, designing, and developing your questionnaire.
        BMJ. 2004; 328: 1312-1315
        • Cook D.
        • Beckman T.
        Current concepts in validity and reliability for psychometric instruments: theory and application.
        Am J Med. 2006; 119 (166.e7-16)
        • Tsang S.
        • Royse C.
        • Terkawi A.S.
        Guidelines for developing, translating, and validating a questionnaire in perioperative and pain medicine.
        Saudi J Anaesth. 2017; 11: S80-S89
        • Cunningham C.T.
        • Quan H.
        • Hemmelgarn B.
        • et al.
        Exploring physician specialist response rates to web-based surveys.
        BMC Med Res Methodol. 2015; 15: 4-11