Aims Compare different protocols of PEP prophylaxis.
Methods A retrospective, observational and cross-sectional study was conducted. Patients undergoing ERCP for biliary diseases between 2013 and 2019 were included. Patients diagnosed with any pancreatic disease (pancreatic cancer, chronic pancreatitis, previous acute pancreatitis) and post-surgical altered bilio-pancreatic anatomy were excluded. Patients were divided in four cohorts depending on the type of PEP prophylaxis used in different periods. Group I: rectal diclofenac 100mg in high-risk patients of PEP; group II: rectal diclofenac + LR 500 mL in high-risk patients of PEP; group III: rectal diclofenac + LR 500 mL in every patient undergoing ERCP; group IV rectal indomethacin + LR 500 mL in every patient undergoing ERCP. All patients were monitored for pain and serum pancreatic enzymes over 24h after ERCP. Incidence of PEP was calculated and compared by ANOVA. Risk factors for PEP were analysed by logistic regression.
Results 1,621 patients were included, mean age 71 ± 15 years, 832 males, 455 in group I, 254 in group II, 728 in group III and 184 in group IV. The global incidence of PEP was 3.86 % (group I: 2.42 %, group II: 3.94 %, group III: 4.3 % and group IV: 4.9 %, p=0.3). Smoking (OR 9.0 CI 95 % 1.9-42.1) and cannulation of the pancreatic duct (OR 9.1 CI 95 % 1.8-46.0) were the most relevant risk factors for PEP in the era of routine prophylaxis.
Conclusions This study showed that any combination of either rectal indomethacin or diclofenac with hydration with LR in high-risk patients or in every patient undergoing ERCP are equally effective in preventing PEP. Smoking and cannulation of the pancreatic duct are risk factors of PEP in the era of routine prophylaxis.
Citation
Iglesias-Garcia J, Parma Caputo LF, Mejuto R et al. eP366 INCIDENCE OF POST-ENDOSCOPIC RETROGRADE CHOLANGIOGRAPHY PANCREATITIS (PEP) ACCORDING TO THE PROTOCOL OF PROPHYLAXIS USED. A RETROSPECTIVE, CROSS-SECTIONAL OBSERVATIONAL STUDY. Endoscopy 2021; 53: S216.
