Reply to Thomson

We appreciate Dr. Thomson’s comments and interest in our recent study regarding the incidence and predictors of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) in patients with suspected sphincter of Oddi dysfunction undergoing biliary or dual sphincterotomy [1]. The difference in the rate of PEP was not deemed to be clinically plausible because the medication used for monitored anesthesia care (MAC) and general anesthesia were basically the same, whereas different classes, usually a benzodiazepine and a narcotic, were used in moderate sedation. We agree that the difference between MAC and moderate sedation could be theoretically explained by the difference in patient tolerance but we believe that this needs to be tested in a properly designed clinical trial. Most patients in our study underwent MAC rather than moderate sedation or general anesthesia, and therefore the sample size in those subgroups might not have been sufficient to show a statistical significance. In response to Dr. Thomson’s specific questions, there were differences between centers in the predilection for the type of sedation used. Age and sex were not significantly different between patients with and those without PEP. Patients with a previous history of pancreatitis were excluded from the study.

• References

• 1 Yaghoobi M, Pauls Q, Durkalski V et al. Incidence and predictors of post-ERCP pancreatitis in patients with suspected sphincter of Oddi dysfunction undergoing biliary or dual sphincterotomy: results from the EPISOD prospective multicenter randomized sham-controlled study. Endoscopy 2015; 47: 884-890