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Title

Prophylaxis of post-ERCP pancreatitis: a practice survey

Authors
Rigaux, Johanne
Kahaleh, Michel
Gomez, Carlos Macias
Vandermeeren, Alain
Deviere, Jacques
Published in Gastrointestinal Endoscopy. 2010, vol. 71, no. 6, p. 934-939, 939 e931-932
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 AdultAnti-Inflammatory Agents, Non-Steroidal/*therapeutic useCholangiopancreatography, Endoscopic Retrograde/*adverse effectsFemaleHealth Care SurveysHumansMaleMiddle AgedPancreatitis/etiology/*prevention & control*Stents
Identifiers
PMID: 20226455
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DUMONCEAU, Jean-Marc et al. Prophylaxis of post-ERCP pancreatitis: a practice survey. In: Gastrointestinal Endoscopy, 2010, vol. 71, n° 6, p. 934-939, 939 e931-932. https://archive-ouverte.unige.ch/unige:20916

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Deposited on : 2012-05-23

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