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Practice patterns of post-ERCP pancreatitis prophylaxis techniques in the United States: a survey of advanced endoscopists.
Gastrointest Endosc. 2020 03; 91(3):568-573.e2.GE

Abstract

BACKGROUND AND AIMS

The American Society for Gastrointestinal Endoscopy recommends prophylactic pancreatic duct stent placement (PPS) and rectal nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce the incidence and severity of post-ERCP pancreatitis (PEP) in high-risk individuals and suggests that rectal indomethacin may decrease the risk and severity of PEP in average-risk individuals. The European Society for Gastrointestinal Endoscopy recommends rectal indomethacin for all patients undergoing ERCP. Previous surveys of European endoscopists revealed low adoption of PPS or rectal NSAIDs to prevent PEP. We sought to capture current practice in the prevention of PEP among endoscopists in the United States involved in advanced endoscopy fellowship programs.

METHODS

An anonymous online 16-item survey was e-mailed to 233 advanced endoscopists involved in advanced endoscopy fellowship programs.

RESULTS

Of the 233 endoscopists who were invited to participate, 62 responded (26.7%). Most respondents reported working in tertiary referral centers (57; 95.0%) and performing ERCP for greater than 5 years (44; 74.6%). All respondents (60; 100.0%) reported working with fellows. Most PPS users (41; 72.0%) reported use of PPS in high-risk patients only and using PPS for PEP in ≤25% of ERCPs (38; 64.4%). Most respondents reported using rectal NSAIDs for high-risk patients only (34; 59.7%) compared with respondents (23; 40.1%) who reported using rectal NSAIDs for prevention of PEP in average-risk patients undergoing ERCP. Most respondents (49; 83.0%) also reported using rapid intravenous fluids to prevent PEP.

CONCLUSIONS

Among endoscopists involved in advanced endoscopy fellowships in the United States, rectal NSAIDs are used more frequently than PPS in the prevention of PEP. Despite mounting evidence supporting the use of rectal NSAIDs to prevent PEP in average-risk patients, less than half of the respondents in this survey reported such practice.

Authors+Show Affiliations

Division of Gastroenterology, University of California, San Francisco, San Francisco, California, USA.Division of Gastroenterology, University of California, San Francisco, San Francisco, California, USA.Division of Gastroenterology, University of California, San Francisco, San Francisco, California, USA.Division of Gastroenterology, University of California, San Francisco, San Francisco, California, USA.Division of Gastroenterology, University of California, San Francisco, San Francisco, California, USA; Division of Gastroenterology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31743690

Citation

Avila, Patrick, et al. "Practice Patterns of post-ERCP Pancreatitis Prophylaxis Techniques in the United States: a Survey of Advanced Endoscopists." Gastrointestinal Endoscopy, vol. 91, no. 3, 2020, pp. 568-573.e2.
Avila P, Holmes I, Kouanda A, et al. Practice patterns of post-ERCP pancreatitis prophylaxis techniques in the United States: a survey of advanced endoscopists. Gastrointest Endosc. 2020;91(3):568-573.e2.
Avila, P., Holmes, I., Kouanda, A., Arain, M., & Dai, S. C. (2020). Practice patterns of post-ERCP pancreatitis prophylaxis techniques in the United States: a survey of advanced endoscopists. Gastrointestinal Endoscopy, 91(3), 568-e2. https://doi.org/10.1016/j.gie.2019.11.013
Avila P, et al. Practice Patterns of post-ERCP Pancreatitis Prophylaxis Techniques in the United States: a Survey of Advanced Endoscopists. Gastrointest Endosc. 2020;91(3):568-573.e2. PubMed PMID: 31743690.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Practice patterns of post-ERCP pancreatitis prophylaxis techniques in the United States: a survey of advanced endoscopists. AU - Avila,Patrick, AU - Holmes,Ian, AU - Kouanda,Abdul, AU - Arain,Mustafa, AU - Dai,Sun-Chuan, Y1 - 2019/11/16/ PY - 2019/08/09/received PY - 2019/11/03/accepted PY - 2019/11/20/pubmed PY - 2021/2/23/medline PY - 2019/11/20/entrez SP - 568 EP - 573.e2 JF - Gastrointestinal endoscopy JO - Gastrointest Endosc VL - 91 IS - 3 N2 - BACKGROUND AND AIMS: The American Society for Gastrointestinal Endoscopy recommends prophylactic pancreatic duct stent placement (PPS) and rectal nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce the incidence and severity of post-ERCP pancreatitis (PEP) in high-risk individuals and suggests that rectal indomethacin may decrease the risk and severity of PEP in average-risk individuals. The European Society for Gastrointestinal Endoscopy recommends rectal indomethacin for all patients undergoing ERCP. Previous surveys of European endoscopists revealed low adoption of PPS or rectal NSAIDs to prevent PEP. We sought to capture current practice in the prevention of PEP among endoscopists in the United States involved in advanced endoscopy fellowship programs. METHODS: An anonymous online 16-item survey was e-mailed to 233 advanced endoscopists involved in advanced endoscopy fellowship programs. RESULTS: Of the 233 endoscopists who were invited to participate, 62 responded (26.7%). Most respondents reported working in tertiary referral centers (57; 95.0%) and performing ERCP for greater than 5 years (44; 74.6%). All respondents (60; 100.0%) reported working with fellows. Most PPS users (41; 72.0%) reported use of PPS in high-risk patients only and using PPS for PEP in ≤25% of ERCPs (38; 64.4%). Most respondents reported using rectal NSAIDs for high-risk patients only (34; 59.7%) compared with respondents (23; 40.1%) who reported using rectal NSAIDs for prevention of PEP in average-risk patients undergoing ERCP. Most respondents (49; 83.0%) also reported using rapid intravenous fluids to prevent PEP. CONCLUSIONS: Among endoscopists involved in advanced endoscopy fellowships in the United States, rectal NSAIDs are used more frequently than PPS in the prevention of PEP. Despite mounting evidence supporting the use of rectal NSAIDs to prevent PEP in average-risk patients, less than half of the respondents in this survey reported such practice. SN - 1097-6779 UR - https://www.unboundmedicine.com/medline/citation/31743690/Practice_patterns_of_post_ERCP_pancreatitis_prophylaxis_techniques_in_the_United_States:_a_survey_of_advanced_endoscopists_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5107(19)32429-0 DB - PRIME DP - Unbound Medicine ER -