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Utilization Pattern of Prophylactic Measures for Prevention of Post-ERCP Pancreatitis: A National Survey Study.

Published:February 02, 2023DOI:https://doi.org/10.1016/j.gie.2023.01.049
Utilization Pattern of Prophylactic Measures for Prevention of Post-ERCP Pancreatitis: A National Survey Study.
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      Abstract

      Background and Aims

      Post ERCP pancreatitis (PEP) is the most frequent adverse event of endoscopic retrograde cholangiopancreatography (ERCP). Various prophylactic measures are endorsed by ASGE (American Society of Gastrointestinal Endoscopy) and ESGE (European Society of Gastrointestinal Endoscopy) to lower the incidence of PEP and decrease severity in PEP. The extent to which these interventions are practiced throughout the United States is unclear. The aim of the study was to describe utilization pattern of various PEP measures and find factors that impact utilization these measures.

      Methods

      A 27-question electronic survey was distributed using a cloud-based program (Qualtrics). Questions assessed ERCP training, practice setting, experience, practice patterns and perceptions for PEP prophylaxis interventions. Endoscopists with practices based in the US listed in the ASGE member directory received a survey invitation via e-mail. The invitation outlined the study and contained a link with instructions to complete the voluntary survey if they had an active ERCP practice. Data was de-identified for the purposes of analysis.

      Results

      Of survey respondents (n=319), 46% reported therapeutic endoscopy fellowship training and 37% practiced in teaching programs. Annualized ERCP volume of >100 cases per year were reported by 47%, with pancreatic ERCP comprising ≤5% of procedures volume reported by majority of respondents (61%). The majority of respondents utilized prophylactic pancreatic stent (PPS) and 54% reported frequent use during high risk ERCP. The most common indications for PPS were difficult cannulation, to assist biliary access and multiple pancreatic duct injections. Most respondents reported frequent use of IND (89%). Of physicians that did not use PPS, use of IND was the most common reason (80%). Variables associated with frequent use of PPS were ERCP fellowship training (p=< 0.001), practice at a teaching program (p=< 0.001), < 10 years in practice (p=0.005), higher procedure volume (p=< 0.001) and higher proportion of pancreatic cases (p=< 0.001).

      Conclusion

      Physicians with higher annual ERCP volume, teaching hospital based ERCP practices and who regularly perform pancreatic ERCP are more likely to use PPS. Therapeutic ERCP fellowship training and recent entry into practice were also associated with PPS utilization. Indomethacin use appears to be more frequent than PPS. Our findings suggest IND is supplanting PPS as the preferred method of PEP prophylaxis.

      Acronyms and Abbreviations:

      PEP (Post ERCP Pancreatitis), ASGE (American Society of Gastrointestinal Endoscopy), ESGE (Europeans Society of Gastrointestinal Endoscopy), MRCP (Magnetic resonance cholangiopancreatography), ERCP (Endoscopic retrograde cholangiopancreatography), EUS (Endoscopic Ultrasound), PPS (Prophylactic Pancreatic Stent)
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      Article info

      Publication history

      Accepted: January 28, 2023
      Received in revised form: January 5, 2023
      Received: November 13, 2022

      Publication stage

      In Press Journal Pre-Proof

      Footnotes

      Gastrointestinal Endoscopy

      Subject: Submission of the manuscript, titled " Utilization Pattern of Prophylactic Measures for Prevention of Post-ERCP Pancreatitis: A National Survey Study”

      Dear Editor, Please find attached here our manuscript titled, “Utilization Pattern of Prophylactic Measures for Prevention of Post-ERCP Pancreatitis: A National Survey Study” for consideration for publication in Gastrointestinal Endoscopy. We confirm that the manuscript is original and has neither been previously published nor is under consideration for publication elsewhere.

      The authors agree to transfer the copyright to your journal if accepted for publication. The work was not supported by grants or endowments. The authors have no conflict of interest to declare. Further correspondence regarding the manuscript should be directed to the corresponding author below. Kindly acknowledge receipt of the manuscript.

      With regards

      Dr. Munish Ashat, Assistant Professor of Medicine, Division of Gastroenterology and Hepatology, University of Iowa Hospitals and Clinics, Iowa, IA, USA. Email: [email protected]

      Guarantor of Article: Dr. Munish Ashat, accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

      Identification

      DOI: https://doi.org/10.1016/j.gie.2023.01.049

      Copyright

      © 2023 by the American Society for Gastrointestinal Endoscopy

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