Introduction Acute pancreatitis is the most common complication following ERCP. In 2010, the European Society of Gastrointestinal Endoscopy delivered Guidelines on the Prophylaxis of post-ERCP pancreatitis (PEP).1 These included Grade A recommendations advising the use of prophylactic pancreatic stents and NSAIDs in high-risk cases. The aim of this study was to capture the current practise of UK biliary endoscopists in the prevention of PEP.
Methods In Summer 2012 an anonymous online 15-item survey was e-mailed to 373 UK Consultant Gastroenterologists, GI Surgeons and Radiologists identified to perform ERCP.
Results The response rate was 59.5% (222/373). Of respondents 52.5% considered ever using prophylactic pancreatic stents (PPS) for the prevention of PEP. Those who used PPS always attempted to do so 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%). The decision to use prophylactic NSAIDs was significantly associated with attempts at PPS placement (p < 0.001).The stent characteristics, follow-up methods and timing varied significantly. Of those who did not use PPS 64.1% 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 IV Fluids (13.2%) and Octreotide (1.6%). Only 6% of respondents routinely measured amylase post-ERCP.
Conclusion Despite strong evidence-based guidelines for prevention of PEP less than 53% of ERCP practitioners either consider using pancreatic stenting or NSAIDs. This suggests a need for the development of BSG guidelines to increase awareness in the UK. Even amongst stent users PPS are being underused for most high risk cases. Pharmacological measures were rarely used for PEP prophylaxis. Routine post-ERCP serum amylase measurement was rare even in day case procedures.
Disclosure of Interest None Declared.
Dumonceau JM, Andrulli A, Deviere J, et al. European Society of Gastrointestinal Endoscopy (ESGE) Guideline: prophylaxis of post-ERCP pancreatitis. Endoscopy. 2010; 42(6):503–15.
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