Research Article|Articles in Press

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

Published:February 02, 2023DOI:
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      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.


      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.


      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).


      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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