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UK wide survey on the prevention of post-ERCP pancreatitis
  1. Mina S Hanna1,
  2. Andrew J Portal1,
  3. Ashwin D Dhanda2,
  4. Robert Przemioslo3
  1. 1Department of Gastroenterology and Hepatology, Bristol Royal Infirmary, University Hospitals Bristol NHS Trust, Bristol, UK
  2. 2School of Clinical Sciences, University of Bristol, Bristol, UK
  3. 3Department of Gastroenterology, Frenchay Hospital, North Bristol NHS Trust, Bristol, UK
  1. Correspondence to Dr Mina S Hanna, Department of Gastroenterology and Hepatology, Bristol Royal Infirmary, Upper Maudlin Street, Bristol BS2 8HW, UK; Mina.Hanna{at}nhs.net

Abstract

Objective In 2010, the European Society of Gastrointestinal Endoscopy delivered guidelines on the prophylaxis of postendoscopic retrograde cholangiopancreatography (post-ERCP) pancreatitis (PEP). These included Grade A recommendations advising the use of prophylactic pancreatic stent (PPS) and non-steroidal anti-inflammatory drugs (NSAIDs) in high-risk cases. Our study aim was to capture the current practice of UK biliary endoscopists in the prevention of PEP.

Design In summer 2012, an anonymous online 15-item survey was emailed to 373 UK consultant gastroenterologists, gastrointestinal surgeons and radiologists identified to perform ERCP.

Results The response rate was 59.5% (222/373). Of the respondents, 52.5% considered ever using PPS for the prevention of PEP. PPS users always attempted insertion for the following procedural risk factors: pancreatic sphincterotomy (48.9%), suspected sphincter of Oddi dysfunction (46.5%), pancreatic duct instrumentation (35.9%), previous PEP (25.2%), precut sphincterotomy (8.5%) and pancreatic duct injection (7.8%). Prophylactic NSAID use was significantly associated with attempts at PPS placement (p<0.001). 64.1% of non-PPS users cited a lack of conviction in their benefit as the main reason for their decision. Self-reported pharmacological use rates for PEP prevention were: NSAIDs (34.6%), antibiotics (20.6%), rapid intravenous fluids (13.2%) and octreotide (1.6%). 6% routinely measured amylase post-ERCP.

Conclusions Despite strong evidence-based guidelines for prevention of PEP, less than 53% of ERCP practitioners use pancreatic stenting or NSAIDs. This suggests a need for the development of British Society of Gastroenterology guidelines to increase awareness in the UK. Even among stent users, PPS are being underused for most high-risk cases. Prophylactic pharmacological measures were rarely used as was routine post-ERCP serum amylase measurement.

  • Endoscopic Retrograde Pancreatography
  • Pancreatitis
  • Stents
  • Non-Steroidal Anti-Inflammatory Drugs

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