Prophylaxis of post-ERCP pancreatitis: a practice survey

Area of Science:

• Gastroenterology
• Endoscopic Procedures
• Pancreatic Diseases

Background:

• Post-ERCP pancreatitis (PEP) is a significant risk following endoscopic retrograde cholangiopancreatography (ERCP).
• Prophylactic pancreatic stenting and nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly considered for PEP prevention.
• Expert endoscopists widely employ prophylactic pancreatic stenting, while NSAIDs are thought to prevent PEP.

Purpose of the Study:

• To evaluate the current adoption rates of pancreatic stenting and NSAIDs for PEP prophylaxis among endoscopists.
• To identify factors influencing the use of these prophylactic measures.

Main Methods:

• A survey was administered to 141 endoscopists from 29 countries who perform ERCP.
• Data collected included the frequency of prophylactic pancreatic stenting for various indications and reasons for non-use.
• The study assessed the utilization of NSAIDs for PEP prophylaxis.

Main Results:

• Less than half of surveyed endoscopists used prophylactic pancreatic stenting in most cases, with 21.3% not using it at all, often due to inexperience.
• Higher PEP incidence and annual hospital ERCP volume (>500) were associated with increased use of prophylactic pancreatic stenting.
• A significant majority (83.7%) of respondents did not use NSAIDs for PEP prophylaxis, citing a lack of scientific evidence.

Conclusions:

• The adoption of prophylactic pancreatic stenting for PEP prevention is less widespread than anticipated, despite established benefits.
• The use of NSAIDs for PEP prophylaxis is minimal among surveyed endoscopists.
• Practice patterns may be influenced by experience and perceived evidence of efficacy.