Practice patterns of post-ERCP pancreatitis prophylaxis techniques in the United States: a survey of advanced endoscopists

Avila, Patrick; Holmes, Ian; Kouanda, Abdul; Arain, Mustafa A.; Dai, Sun-Chuan

doi:10.1016/j.gie.2019.11.013

Cited by 35 publications

(25 citation statements)

References 22 publications

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“…22,23 However, in a recent survey of advanced endoscopists in the United States, 98.4% self-reported use of NSAIDs and 83% reported use of rapid intravenous fluids to prevent PEP. 24 We observed a significant increase in the overall incidence rate of PEP-related hospital admissions from 4.29% in 2011 to 5.22% in 2017 (OR 1.23, 95% CI 1.04-1.46; p = 0.016). This is despite a downward trend in the number of total inpatient ERCPs during this time period and the widespread use of rectal NSAIDs and rapid intravenous fluids to prevent PEP.…”

Section: Discussionmentioning

confidence: 72%

“…▶ [22,23]. However, in a recent survey of advanced endoscopists in the United States, 98.4 % reported using NSAIDs and 83 % reported using rapid intravenous fluids to prevent PEP [24]. We observed a significant increase in the overall incidence of PEP-related hospital admissions, from 4.3 % in 2011 to 5.2 % in 2017 (OR 1.23, 95 %CI 1.04 -1.46; P = 0.02).…”

Section: Discussionmentioning

confidence: 99%

“…multivariable analysis, the co-morbidities associated with significantly higher odds of PEP were obesity (OR 1.12, 95% CI 1.02-1 24,. p=0.007), CKD (OR 1.39, 95% CI 1.31-1.48; p<0.01), ESRD (OR 1.86, 95% CI 1.59-2.19, p<0.01) and CHF (OR 1.33,95% CI 1.25-1.41; p<0.01).…”

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confidence: 95%

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Temporal trends and mortality of post-ERCP pancreatitis in the United States: a nationwide analysis

Mutneja

Vohra

et al. 2020

Endoscopy

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BACKGROUND AND STUDY AIMS: Post-ERCP pancreatitis (PEP) is the most common and serious complication of ERCPs. Our aim was to estimate the nationwide incidence, temporal trends and mortality of PEP and establish its risk-factors in the United States. METHODS: This was a retrospective cohort study analyzing the Nationwide Inpatient Sample (NIS) data from 2011 to 2017 using ICD codes. The primary outcomes were to assess the trends of post-ERCP pancreatitis (PEP) and the predictors of occurrence of PEP. Secondary outcomes were in-hospital mortality, length of stay and ICU admission. RESULTS: Of the 1,222,467 adult patients who underwent inpatient ERCP during the study period, 55,225 (4.5%) developed post-ERCP pancreatitis. The hospital admission rate of PEP increased by 13.3% from 7,735 in 2011 to 8,920 in 2017 (OR 1.23, 95% CI 1.04-1.46; p = 0.016). The overall rate of mortality increased from 2.75% of PEP cases in 2011 to 4.38% in 2017 (OR: 1.62, 95% CI 1.10-2.38, p = 0.014). Multiple patient-related (alcohol use, cocaine use, obesity, chronic kidney disease, heart failure), procedure-related (therapeutic ERCP, sphincterotomy, pancreatic duct stent placement, sphincter of Oddi dysfunction) and hospital-related factors (teaching hospitals, hospitals located in West and Mid-west) that impact the occurrence of PEP were identified. CONCLUSIONS: Our study shows a rising hospital admission rate and mortality associated with PEP in the United States. This calls for a greater recognition of this life-threatening complication and amelioration of its risk-factors, whenever possible.

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

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Temporal trends and mortality of post-ERCP pancreatitis in the United States: a nationwide analysis

Mutneja

Vohra

et al. 2020

Endoscopy

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“…This has led to slow adoption in the community: In 10 years, the proportion of endoscopists who use rectal NSAIDs for PEP prophylaxis has increased from 15 % to 54 % to 98 % 1 2 3 4 . The latest survey reported use of rectal NSAIDs by 98 % of pancreaticobiliary endoscopists but by only 40 % of them in average-risk patients 4 . This is despite the demonstration of NSAID efficacy in this risk category of patients by 11 of 14 meta-analyses published to date 5 .…”

Section: Tablementioning

confidence: 99%

Should we incorporate topical epinephrine in the ESGE guideline on prevention of post-ERCP pancreatitis?

Toussaint

Dumonceau

2020

Endosc Int Open

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“…Rectal nonsteroidal anti-inflammatory drugs (NSAIDs) have been investigated in multiple randomized controlled trials for reducing the incidence of PEP (14)(15)(16)(17). NSAIDs are believed to limit the risk of developing acute pancreatitis via the inhibition of inflammatory mediators that trigger a complex cascade of inflammatory events; this is a critical process in the pathogenesis of pancreatitis.…”

Section: Introductionmentioning

confidence: 99%

Prophylactic effect of rectal indomethacin plus nitroglycerin administration for preventing pancreatitis after endoscopic retrograde cholangiopancreatography in female patients

Wang

Zhang

et al. 2020

Ann Palliat Med

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Background: Prophylactic pancreatic stent placement (PSP) and rectal indomethacin suppository are recommended to prevent post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) in high-risk cases. Clinical trials on the use of nitroglycerin to reduce PEP have reached no definitive conclusion. Our study aimed to determine whether treatment with rectal indomethacin plus nitroglycerin could eliminate the need for PSP in patients.Methods: In this randomized clinical trial, patients were allocated into groups using a random number table, with each patient receiving a pre-made envelope containing their intervention prior to ERCP. The three treatment groups were: the placebo group, the indomethacin + nitroglycerin group, and the PSP group.The subjects were assessed for PEP and its severity by a panel of independent and blinded adjudicators.Results: A total of 526 patients were eligible for inclusion. The placebo group included 176 patients, the indomethacin + nitroglycerin group included 176 patients and the PSP group included 174.A diagnosis of PEP was made in 64 (12.2%) cases. The rate of PEP in the three study groups placebo group, indomethacin + nitroglycerin group and the PSP group was 19.3%, 5.1%, and 12.1%, respectively. Conclusions:The risk of post-ERCP pancreatitis in the indomethacin + nitroglycerin group was 7% lower than that in the PSP. Indomethacin + nitroglycerin is superior to PSP in preventing and relieving the severity of post-ERCP pancreatitis in patients with difficult intubation. Indomethacin plus nitroglycerin can avoid the need for PSP in the prevention of post-ERCP pancreatitis.

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Practice patterns of post-ERCP pancreatitis prophylaxis techniques in the United States: a survey of advanced endoscopists

Cited by 35 publications

References 22 publications

Temporal trends and mortality of post-ERCP pancreatitis in the United States: a nationwide analysis

Temporal trends and mortality of post-ERCP pancreatitis in the United States: a nationwide analysis

Should we incorporate topical epinephrine in the ESGE guideline on prevention of post-ERCP pancreatitis?

Prophylactic effect of rectal indomethacin plus nitroglycerin administration for preventing pancreatitis after endoscopic retrograde cholangiopancreatography in female patients

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