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Gastrointest Endosc. 2010 May;71(6):934-9, 939.e1-2. doi: 10.1016/j.gie.2009.10.055. Epub 2010 Mar 11.

Prophylaxis of post-ERCP pancreatitis: a practice survey.

Author information

1
Division of Gastroenterology and Hepatology, Geneva University Hospitals, Geneva, Switzerland.

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 < or = 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 > or = 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.

PMID:
20226455
DOI:
10.1016/j.gie.2009.10.055
[Indexed for MEDLINE]

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