Risk Factors for Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis in the Indomethacin Era – A Prospective Study
Background and Aims: Although endoscopic retrograde cholangiopancreatography (ERCP) is an essential procedure used to treat conditions affecting the biliopancreatic system, it can lead to several complications. Post-ERCP pancreatitis (PEP) is the most frequent one, with an incidence ranging from 3 t...
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| Published in | GE Portuguese journal of gastroenterology Vol. 26; no. 3; pp. 176 - 183 |
|---|---|
| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | English Portuguese |
| Published |
Basel, Switzerland
S. Karger AG
01.05.2019
Sociedade Portuguesa de Gastrenterologia Karger Publishers |
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| Abstract | Background and Aims: Although endoscopic retrograde cholangiopancreatography (ERCP) is an essential procedure used to treat conditions affecting the biliopancreatic system, it can lead to several complications. Post-ERCP pancreatitis (PEP) is the most frequent one, with an incidence ranging from 3 to 14%. Our aim was to assess the potential risk factors associated with PEP occurrence in patients undergoing ERCP with indomethacin prophylaxis. Methods: Prospective, single-center, real-world observational study (January to December 2015) with inclusion of patients submitted to ERCP, where relevant patient-related and procedure-related data had been collected. Patients had to have been admitted for a minimum of 24 h in order to establish the presence of early complications. All patients were submitted to PEP prophylaxis with 1 or 2 methods: rectal indomethacin and pancreatic duct (PD) stenting. Results: A total of 188 patients who had undergone ERCP were included (52.7% women; mean age 69.2 ± 16.0 years) and PEP was diagnosed in 13 (6.9%). PEP prophylaxis consisted of indomethacin in all cases (100%) and PD stenting in 7.4%. The pancreatitis was mild in 11 patients (84.6%) and severe in the other 2. One of them died (0.5%). None of the patient-related risk factors were associated with changes in PEP probability. Of all patients, 33.0% had 2 or more procedure-related risk factors. A higher number of synchronous procedure-related risk factors showed a statistically significant correlation with PEP occurrence, p = 0.040. Conclusions: The 6.9% PEP rate is considered acceptable since 33.0% patients had a medium-high risk for PEP due to challenging biliary cannulation. The total number of procedure-related risk factors seems to play a critical role in the development of PEP despite indomethacin prophylaxis. |
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| AbstractList | Although endoscopic retrograde cholangiopancreatography (ERCP) is an essential procedure used to treat conditions affecting the biliopancreatic system, it can lead to several complications. Post-ERCP pancreatitis (PEP) is the most frequent one, with an incidence ranging from 3 to 14%. Our aim was to assess the potential risk factors associated with PEP occurrence in patients undergoing ERCP with indomethacin prophylaxis.
Prospective, single-center, real-world observational study (January to December 2015) with inclusion of patients submitted to ERCP, where relevant patient-related and procedure-related data had been collected. Patients had to have been admitted for a minimum of 24 h in order to establish the presence of early complications. All patients were submitted to PEP prophylaxis with 1 or 2 methods: rectal indomethacin and pancreatic duct (PD) stenting.
A total of 188 patients who had undergone ERCP were included (52.7% women; mean age 69.2 ± 16.0 years) and PEP was diagnosed in 13 (6.9%). PEP prophylaxis consisted of indomethacin in all cases (100%) and PD stenting in 7.4%. The pancreatitis was mild in 11 patients (84.6%) and severe in the other 2. One of them died (0.5%). None of the patient-related risk factors were associated with changes in PEP probability. Of all patients, 33.0% had 2 or more procedure-related risk factors. A higher number of synchronous procedure-related risk factors showed a statistically significant correlation with PEP occurrence,
= 0.040.
The 6.9% PEP rate is considered acceptable since 33.0% patients had a medium-high risk for PEP due to challenging biliary cannulation. The total number of procedure-related risk factors seems to play a critical role in the development of PEP despite indomethacin prophylaxis. Background and Aims: Although endoscopic retrograde cholangiopancreatography (ERCP) is an essential procedure used to treat conditions affecting the biliopancreatic system, it can lead to several complications. Post-ERCP pancreatitis (PEP) is the most frequent one, with an incidence ranging from 3 to 14%. Our aim was to assess the potential risk factors associated with PEP occurrence in patients undergoing ERCP with indomethacin prophylaxis. Methods: Prospective, single-center, real-world observational study (January to December 2015) with inclusion of patients submitted to ERCP, where relevant patient-related and procedure-related data had been collected. Patients had to have been admitted for a minimum of 24 h in order to establish the presence of early complications. All patients were submitted to PEP prophylaxis with 1 or 2 methods: rectal indomethacin and pancreatic duct (PD) stenting. Results: A total of 188 patients who had undergone ERCP were included (52.7% women; mean age 69.2 ± 16.0 years) and PEP was diagnosed in 13 (6.9%). PEP prophylaxis consisted of indomethacin in all cases (100%) and PD stenting in 7.4%. The pancreatitis was mild in 11 patients (84.6%) and severe in the other 2. One of them died (0.5%). None of the patient-related risk factors were associated with changes in PEP probability. Of all patients, 33.0% had 2 or more procedure-related risk factors. A higher number of synchronous procedure-related risk factors showed a statistically significant correlation with PEP occurrence, p = 0.040. Conclusions: The 6.9% PEP rate is considered acceptable since 33.0% patients had a medium-high risk for PEP due to challenging biliary cannulation. The total number of procedure-related risk factors seems to play a critical role in the development of PEP despite indomethacin prophylaxis. BACKGROUND AND AIMSAlthough endoscopic retrograde cholangiopancreatography (ERCP) is an essential procedure used to treat conditions affecting the biliopancreatic system, it can lead to several complications. Post-ERCP pancreatitis (PEP) is the most frequent one, with an incidence ranging from 3 to 14%. Our aim was to assess the potential risk factors associated with PEP occurrence in patients undergoing ERCP with indomethacin prophylaxis. METHODSProspective, single-center, real-world observational study (January to December 2015) with inclusion of patients submitted to ERCP, where relevant patient-related and procedure-related data had been collected. Patients had to have been admitted for a minimum of 24 h in order to establish the presence of early complications. All patients were submitted to PEP prophylaxis with 1 or 2 methods: rectal indomethacin and pancreatic duct (PD) stenting. RESULTSA total of 188 patients who had undergone ERCP were included (52.7% women; mean age 69.2 ± 16.0 years) and PEP was diagnosed in 13 (6.9%). PEP prophylaxis consisted of indomethacin in all cases (100%) and PD stenting in 7.4%. The pancreatitis was mild in 11 patients (84.6%) and severe in the other 2. One of them died (0.5%). None of the patient-related risk factors were associated with changes in PEP probability. Of all patients, 33.0% had 2 or more procedure-related risk factors. A higher number of synchronous procedure-related risk factors showed a statistically significant correlation with PEP occurrence, p = 0.040. CONCLUSIONSThe 6.9% PEP rate is considered acceptable since 33.0% patients had a medium-high risk for PEP due to challenging biliary cannulation. The total number of procedure-related risk factors seems to play a critical role in the development of PEP despite indomethacin prophylaxis. |
| Author | Tomé, Luís Perdigoto, David N. Gomes, Dário Mendes, Sofia Alves, Ana Rita Camacho, Ernestina Almeida, Nuno |
| AuthorAffiliation | a Gastroenterology Department, Coimbra Hospital and University Center, Coimbra, Portugal b Medical School, Coimbra University, Coimbra, Portugal |
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| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/31192286$$D View this record in MEDLINE/PubMed |
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| Copyright | 2018 Sociedade Portuguesa de Gastrenterologia Published by S. Karger AG, Basel Copyright © 2018 by Sociedade Portuguesa de Gastrenterologia Published by S. Karger AG, Basel 2018 This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. |
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| DocumentTitleAlternate | Fatores de Risco para a Pancreatite pós-Colangiopancreatografia Retrógrada Endoscópica na Era da Indometacina: Um Estudo Prospetivo |
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| Keywords | Post-ERCP pancreatitis Pancreatic duct stent Endoscopic retrograde cholangiopancreatography Indomethacin ERCP complications Prótese pancreática Pancreatite pós-CPRE Complicações de CPRE Indometacina CPRE |
| Language | English Portuguese |
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Mariani, A; Curioni, S – volume: 65 start-page: 624 year: 2007 end-page: 632 article-title: Prophylactic administration of somatostatin or gabexate does not prevent pancreatitis after ERCP: an updated meta-analysis publication-title: Gastrointest Endosc contributor: fullname: Andriulli, A; Leandro, G; Federici, T – volume: 366 start-page: 1414 year: 2012 end-page: 1422 article-title: A randomized trial of rectal indomethacin to prevent post-ERCP pancreatitis publication-title: N Engl J Med contributor: fullname: Elmunzer, BJ; Scheiman, JM; Lehman, GA – volume: 52 start-page: 1768 year: 2003 end-page: 1773 article-title: Intravenous bolus somatostatin after diagnostic cholangiopancreatography reduces the incidence of pancreatitis associated with therapeutic endoscopic retrograde cholangiopancreatography procedures: a randomised controlled trial publication-title: Gut contributor: fullname: Poon, RT; Yeung, C; Liu, CL – volume: 62 start-page: 102 year: 2013 end-page: 111 article-title: Classification of acute pancreatitis - 2012: revision of the Atlanta classification and definitions by international consensus publication-title: Gut contributor: fullname: Banks, PA; Bollen, TL; Dervenis, C – volume: 56 start-page: 488 year: 2002 end-page: 495 article-title: Gabexate or somatostatin administration before ERCP in patients at high risk for post-ERCP pancreatitis: a multicenter, placebo-controlled, randomized clinical trial publication-title: Gastrointest Endosc contributor: fullname: Andriulli, A; Clemente, R; Solmi, L – volume: 56 start-page: 202 year: 2002 end-page: 208 article-title: Nifedipine for prevention of post-ERCP pancreatitis: a prospective, double-blind randomized study publication-title: Gastrointest Endosc contributor: fullname: Prat, F; Amaris, J; Ducot, B – volume: 42 start-page: 842 year: 2010 end-page: 853 article-title: Prophylactic pancreatic stent placement and postERCP pancreatitis: a systematic review and meta-analysis publication-title: Endoscopy contributor: fullname: Mazaki, T; Masuda, H; Takayama, T – volume: 49 start-page: 343 year: 2014 end-page: 355 article-title: Prophylactic pancreatic stent placement and postERCP pancreatitis: an updated meta-analysis publication-title: J Gastroenterol contributor: fullname: Mazaki, T; 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Andriulli, A; Elmunzer, BJ |
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| Snippet | Background and Aims: Although endoscopic retrograde cholangiopancreatography (ERCP) is an essential procedure used to treat conditions affecting the... Although endoscopic retrograde cholangiopancreatography (ERCP) is an essential procedure used to treat conditions affecting the biliopancreatic system, it can... BACKGROUND AND AIMSAlthough endoscopic retrograde cholangiopancreatography (ERCP) is an essential procedure used to treat conditions affecting the... |
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| SubjectTerms | Cotton Endoscopic retrograde cholangiopancreatography Endoscopy ERCP complications GASTROENTEROLOGY & HEPATOLOGY Hydration Indomethacin Meta-analysis Nonsteroidal anti-inflammatory drugs Original Original Article Pancreatic duct stent Pancreatitis Patients Post-ERCP pancreatitis Prevention Risk factors |
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| Title | Risk Factors for Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis in the Indomethacin Era – A Prospective Study |
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