en
Scientific article
English

Prophylaxis of post-ERCP pancreatitis: a practice survey

Published inGastrointestinal endoscopy, vol. 71, no. 6, p. 934-939,939e931-932
Publication date2010
Abstract

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.

Keywords
  • Adult
  • Anti-Inflammatory Agents, Non-Steroidal/*therapeutic use
  • Cholangiopancreatography, Endoscopic Retrograde/*adverse effects
  • Female
  • Health Care Surveys
  • Humans
  • Male
  • Middle Aged
  • Pancreatitis/etiology/*prevention & control
  • *Stents
Citation (ISO format)
DUMONCEAU, Jean-Marc et al. Prophylaxis of post-ERCP pancreatitis: a practice survey. In: Gastrointestinal endoscopy, 2010, vol. 71, n° 6, p. 934–939,939e931–932. doi: 10.1016/j.gie.2009.10.055
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ISSN of the journal0016-5107
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