Id: 3517382 the Clinical Impact of Covid-19 Delays on Plastic Biliary Stent Removal

Abstract

Primary outcome was the incidence of PEP. The diagnosis and severity of PEP were defined by the ASGE lexicon for endoscopic adverse events. Patient-related factors, operator-related factors, procedure-related factors and preventive measures were accumulated. The risk factors and preventive measures for PEP were examined by using univariate and multivariate analyses. Results: A total of 16,032 ERCP procedures were performed in the 36 centers during the period, 3,739 ERCPs were enrolled in this study. The average of age was 72.5 years and 43.7% of patients were women. PEP developed in 258 cases (6.9%); 201 mild, 39 moderate, 17 severe, and 1 fatal. Multivariate analysis was performed using 20 risk factors and 8 preventive measures. On multivariate analysis, the significant factors were women under 50 years old, ASA-PS 3, normal serum bilirubin level, obstruction of main pancreatic duct at the pancreatic head, guidewire insertion for the pancreatic duct, total procedure time >60 minutes, prophylactic pancreatic stenting, rectal administration of NSAIDs after ERCP, and spraying saline-epinephrine (Table 1, 2). Conclusions: The extracted risk factors for PEP were young women, normal serum bilirubin level, guidewire insertion for pancreatic duct and prolonged procedure time. Prophylactic pancreatic stenting and spraying saline-epinephrine were suggested to be effective as preventive measures for PEP. The administration of NSAIDs after ERCP was considered a risk factor rather than a preventive measure. However, since the operators decided to administer NSAIDs based on the patient conditions during and after the procedures, then we have to consider what factors were hidden behind the post-ERCP NSAIDs administration.