Knowledge, attitude, and the practices in prevention of post endoscopic retrograde cholangiopancreatography pancreatitis (PEP) among advanced endoscopists.
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Abstract
Background and Aims: PEP is the most dreaded complication of endoscopic retrograde cholangiopancreatography (ERCP). We sought to capture the various practise methods amongst advanced endoscopists regarding measures taken for prevention of PEP.
Methods: An anonymous online 31-item survey was sent to advanced endoscopists by social media platforms like WhatsApp, Twitter and E-mail. The responses were collected over a period of 2 weeks.
Results: Of the 600 endoscopists who were invited to participate, 123 responded. Eighty-seven percentage of endoscopists believe their PEP rate was around 0 to 5 %. Thirty seven percent use intravenous hydration (IV) only in patients deemed as high risk for PEP. Majority (91.8%) use Ringer’s lactate solution for the prevention of PEP. Standard hydration was the norm in using IV fluids in prevention of PEP amongst most endoscopists (67.5%). Forty percentage endoscopists put pancreatic ductal (PD) stent after more than two inadvertent PD cannulation. About 11% endoscopists felt that there was no therapeutic benefit of PD stenting after inadvertent cannulation. About 97 % endoscopists would use rectal nonsteroidal anti-inflammatory drugs (NSAIDs) if there are no contraindication to use. Sixty-nine percentage endoscopists use rectal NSAIDs in high-risk patients only. About 60 % endoscopists use rectal NSAIDs after ERCP. Eighty-nine percentage of endoscopists use combined therapy for PEP. The most commonly used combination is rectal NSAID with standard hydration. If pancreatic ductal stenting is done due to inadvertent cannulation, 72 % endoscopists would still use intravenous hydration with rectal NSAID as additional mode of prophylaxis.
Conclusions: As per our survey, Rectal NSAID is most preferred method for PEP prophylaxis. Rectal NSAID with standard hydration is more commonly used. Most endoscopist prefer to use pancreatic stent in high-risk situation.