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The risk of post-ERCP pancreatitis and the protective effect of rectal indomethacin in cases of attempted but unsuccessful prophylactic pancreatic stent placement.
Gastrointest Endosc. 2015 Jan; 81(1):150-5.GE

Abstract

BACKGROUND

It is believed, based on limited observational data, that an unsuccessful attempt to place a prophylactic pancreatic stent substantially increases the risk of post-ERCP pancreatitis (PEP).

OBJECTIVE

To better understand the risk of PEP in patients with failed pancreatic stent placement (FPS) and the impact of rectal indomethacin on this risk.

DESIGN

Secondary analysis of randomized, controlled trial data.

SETTING

University of Michigan and Indiana University.

PATIENTS

A total of 577 clinical trial participants at elevated risk for PEP.

INTERVENTIONS

Pancreatic stent placement.

MAIN OUTCOME MEASUREMENTS

Within the placebo group, we compared PEP rates in patients with FPS, patients who underwent successful stent placement, and in those without a stent attempt. We also performed a regression analysis evaluating the association between FPS and PEP. To define the protective effect of indomethacin, we repeated these analyses in the indomethacin group and in the full study cohort.

RESULTS

The incidence of PEP among patients in the placebo group who experienced FPS was 34.7%, significantly exceeding rates in patients who underwent successful stent placement (16.4%) and in those without a stent attempt (12.1%). After we adjusted for known PEP risk factors, FPS was found to be independently associated with PEP. Among the indomethacin group and in the full cohort, FPS was not associated with a higher risk of PEP.

LIMITATIONS

Low event rate, FPS not prospectively captured.

CONCLUSION

FPS appears to confer an increased risk of PEP, which is attenuated by rectal indomethacin administration. These findings highlight the importance of adequate training and proficiency before endoscopists attempt pancreatic stent placement and the routine use of rectal indomethacin in high-risk ERCP cases.

Authors+Show Affiliations

Division of Gastroenterology, University of Michigan Medical Center, Ann Arbor, Michigan, USA.Division of Gastroenterology, Indiana University Medical Center, Indianapolis, Indiana, USA.Division of Gastroenterology, Indiana University Medical Center, Indianapolis, Indiana, USA.Division of Gastroenterology, Medical University of South Carolina, Charleston, South Carolina, USA.Division of Gastroenterology, University of Michigan Medical Center, Ann Arbor, Michigan, USA.Division of Gastroenterology, University of Michigan Medical Center, Ann Arbor, Michigan, USA.Division of Gastroenterology, University Hospitals Case Medical Center, Cleveland, Ohio, USA.Division of Digestive Diseases and Nutrition, University of Kentucky Medical Center, Lexington, Kentucky, USA; Division of Gastroenterology and Hepatology, Kantonsspital Graubuenden, Chur, Switzerland.Division of Gastroenterology, University of Michigan Medical Center, Ann Arbor, Michigan, USA.Division of Gastroenterology, University of Michigan Medical Center, Ann Arbor, Michigan, USA.Division of Gastroenterology, Indiana University Medical Center, Indianapolis, Indiana, USA.Division of Gastroenterology, Indiana University Medical Center, Indianapolis, Indiana, USA.Division of Gastroenterology, Indiana University Medical Center, Indianapolis, Indiana, USA.Division of Gastroenterology, University of Michigan Medical Center, Ann Arbor, Michigan, USA.No affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

25527053

Citation

Choksi, Neel S., et al. "The Risk of post-ERCP Pancreatitis and the Protective Effect of Rectal Indomethacin in Cases of Attempted but Unsuccessful Prophylactic Pancreatic Stent Placement." Gastrointestinal Endoscopy, vol. 81, no. 1, 2015, pp. 150-5.
Choksi NS, Fogel EL, Cote GA, et al. The risk of post-ERCP pancreatitis and the protective effect of rectal indomethacin in cases of attempted but unsuccessful prophylactic pancreatic stent placement. Gastrointest Endosc. 2015;81(1):150-5.
Choksi, N. S., Fogel, E. L., Cote, G. A., Romagnuolo, J., Elta, G. H., Scheiman, J. M., Chak, A., Mosler, P., Higgins, P. D., Korsnes, S. J., Schmidt, S. E., Sherman, S., Lehman, G. A., & Elmunzer, B. J. (2015). The risk of post-ERCP pancreatitis and the protective effect of rectal indomethacin in cases of attempted but unsuccessful prophylactic pancreatic stent placement. Gastrointestinal Endoscopy, 81(1), 150-5. https://doi.org/10.1016/j.gie.2014.07.033
Choksi NS, et al. The Risk of post-ERCP Pancreatitis and the Protective Effect of Rectal Indomethacin in Cases of Attempted but Unsuccessful Prophylactic Pancreatic Stent Placement. Gastrointest Endosc. 2015;81(1):150-5. PubMed PMID: 25527053.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The risk of post-ERCP pancreatitis and the protective effect of rectal indomethacin in cases of attempted but unsuccessful prophylactic pancreatic stent placement. AU - Choksi,Neel S, AU - Fogel,Evan L, AU - Cote,Gregory A, AU - Romagnuolo,Joseph, AU - Elta,Grace H, AU - Scheiman,James M, AU - Chak,Amitabh, AU - Mosler,Patrick, AU - Higgins,Peter D R, AU - Korsnes,Sheryl J, AU - Schmidt,Suzette E, AU - Sherman,Stuart, AU - Lehman,Glen A, AU - Elmunzer,B Joseph, AU - ,, PY - 2014/04/03/received PY - 2014/07/11/accepted PY - 2014/12/21/entrez PY - 2014/12/21/pubmed PY - 2015/8/19/medline SP - 150 EP - 5 JF - Gastrointestinal endoscopy JO - Gastrointest Endosc VL - 81 IS - 1 N2 - BACKGROUND: It is believed, based on limited observational data, that an unsuccessful attempt to place a prophylactic pancreatic stent substantially increases the risk of post-ERCP pancreatitis (PEP). OBJECTIVE: To better understand the risk of PEP in patients with failed pancreatic stent placement (FPS) and the impact of rectal indomethacin on this risk. DESIGN: Secondary analysis of randomized, controlled trial data. SETTING: University of Michigan and Indiana University. PATIENTS: A total of 577 clinical trial participants at elevated risk for PEP. INTERVENTIONS: Pancreatic stent placement. MAIN OUTCOME MEASUREMENTS: Within the placebo group, we compared PEP rates in patients with FPS, patients who underwent successful stent placement, and in those without a stent attempt. We also performed a regression analysis evaluating the association between FPS and PEP. To define the protective effect of indomethacin, we repeated these analyses in the indomethacin group and in the full study cohort. RESULTS: The incidence of PEP among patients in the placebo group who experienced FPS was 34.7%, significantly exceeding rates in patients who underwent successful stent placement (16.4%) and in those without a stent attempt (12.1%). After we adjusted for known PEP risk factors, FPS was found to be independently associated with PEP. Among the indomethacin group and in the full cohort, FPS was not associated with a higher risk of PEP. LIMITATIONS: Low event rate, FPS not prospectively captured. CONCLUSION: FPS appears to confer an increased risk of PEP, which is attenuated by rectal indomethacin administration. These findings highlight the importance of adequate training and proficiency before endoscopists attempt pancreatic stent placement and the routine use of rectal indomethacin in high-risk ERCP cases. SN - 1097-6779 UR - https://www.unboundmedicine.com/medline/citation/25527053/The_risk_of_post_ERCP_pancreatitis_and_the_protective_effect_of_rectal_indomethacin_in_cases_of_attempted_but_unsuccessful_prophylactic_pancreatic_stent_placement_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5107(14)01982-8 DB - PRIME DP - Unbound Medicine ER -