Prophylaxis of post-ERCP pancreatitis: a practice survey

Dumonceau, Jean‐Marc; Rigaux, Johanne; Kahaleh, Michel; Gómez, Carlos Macías; Vandermeeren, Alain; Devière, Jacques

doi:10.1016/j.gie.2009.10.055

Cited by 87 publications

(65 citation statements)

References 30 publications

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“…Such results led the European Society of Gastrointestinal Endoscopy (ESGE) to recommend the use of indomethacin or diclofenac either before or after ERCP procedures from 2010 in their guidelines (18,19). In 2012, Elmuntzer et al (12) reported a multicenter, randomized, controlled study that found a significant decrease in PEAP risk among high-risk patients that received rectal indomethacin after the procedure, even though over 80% of subjects had a pancreatic stent.…”

Section: Discussionmentioning

confidence: 99%

Rectal diclofenac does not prevent post-ERCP pancreatitis in consecutive high-risk and low-risk patients

2018

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Objective: rectal diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) that is used to prevent pancreatitis in high-risk patients during endoscopic retrograde cholangiopancreatography (ERCP). The European Society of Gastrointestinal Endoscopy (ESGE) recommends the use of prophylaxis with indomethacin or diclofenac in all patients undergoing ERCP, including those at low or intermediate risk of pancreatitis. A study to investigate the efficacy of this recommendation was performed.Methods: this was a mixed cohort study. A total of 1,512 ERCP procedures performed in our institution from January 2009 to July 2016 were included in the study. Until June 2012, 718 patients did not receive diclofenac. Subsequently, 794 patients without contraindications received 100 mg of rectal diclofenac at the onset of the procedure.Risk factors for post-ERCP pancreatitis (PEAP) and PEAP cases defined using consensus criteria were recorded.Results: a total of 47 PEAP events (3.1%) were reported, 3.4% in the diclofenac group and 2.8% in the non-diclofenac group (p = 0.554); 26.1% of patients had risk factors for PEAP. In the diclofenac group, PEAP developed in 4.4%, 0.5% and 2.6% of subjects with intact papillae, prior sphincterotomy and extended sphincterotomy, respectively. The results were similar for the non-diclofenac group: 4% with intact papillae, 0.9% with prior sphincterotomy, and 2.5% with extended sphincterotomy, respectively. PEAP severity was similar in both groups.Conclusions: rectal diclofenac before ERCP did not prevent the development of post-ERCP acute pancreatitis in non-selected consecutive patients.

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Section: Discussionmentioning

confidence: 99%

Rectal diclofenac does not prevent post-ERCP pancreatitis in consecutive high-risk and low-risk patients

2018

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“…Precutting (transpancreatic pre-cut, needle-knife pre-cut, needle-knife fistulotomy, and needle-knife pre-cut over pancreatic stent) is the most popular technique when standard cannulation fails. In the search for an alternative technique when standard cannulation fails, fistulotomy above the papillary orifice has been considered in some studies [1][2][3][8][9][10] . In our study, we demonstrated that the starting point of the fistulotomy on the papilla (distal third, midportion or proximal third) and the length of the incision varied depending on the disorder being treated (bile duct stones, strictures, etc.)…”

Section: Discussionmentioning

confidence: 99%

Comparison between needle-knife fistulotomy and standard cannulation in ERCP

Ayoubi¹,

Sansoè²,

Leone³

et al. 2012

WJGE

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AIM:To compare the rates of success and complications of two different methods of access into the common bile duct (CBD). METHODS:Between October 2007 and November 2008, 173 consecutive patients (71 men, 102 women, mean age 68.6 years) requiring endoscopic retrograde cannulation of the papilla and endoscopic treatment were studied. In the first 88 patients CBD cannulation was performed through supra-papillary fistulotomy (group F); in the following 85 patients standard cannulation was performed through the Oddi sphincter (group S). Indications for the procedure were: choledocholithiasis, biliary obstruction, postoperative leak, sclerosing cholangitis, and Mirizzi's syndrome. RESULTS:Deep CBD cannulation was successful in 85/88 patients (96.5%) in group F vs 60/85 patients (70.6%) in group S (P < 0.0001). The remaining 25 group S patients in whom cannulation failed were shifted to fistulotomy. Fistulotomy was successful in 21/25 patients (84%). As for complications, hyperamilasemia occurred in 7 (7.9%) group F patients vs 7 (8.2%) group S patients (P = NS); mild pancreatitis in 1 (1.1%) group F patient vs 5 (5.8%) group S patients (P = NS); bleeding in 3 (3.4%) group F patients vs 3 (3.5%) group S patients (P = NS). CONCLUSION:Needle-knife fistulotomy should represent either the first approach to therapeutic cannulation or rescue therapy after unsuccessful standard cannulation.

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“…Im Rahmen der Prophylaxe der Post-ERCP-Pankreatitis gibt es hingegen bereits vielversprechende Daten, wie eine Metaanalyse von Singh et al [89] zeigen konnte. Aufgrund dieser Daten ist die prophylaktische Pankreasstent implantation bei Papillektomie zu empfehlen und wird auch in der Regel umgesetzt [90]. Es gibt noch keinen Konsens, ob die Pankreasgangstentimplantation vor oder nach der Papillektomie erfolgen soll [76].…”

Section: Technik Der Endoskopischen Papillenresektionunclassified

Endoskopische Papillenresektion: Indikation und Grenzen

Heinzow¹,

Meister

Domagk

2012

Visc Med

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Hintergrund: Adenome der Papilla Vateri sind selten. Prävalenzen von 0,04–0,12% werden beschrieben. Eine maligne Transformation von benignen Adenomen zu Papillenkarzinomen ist möglich und folgt der Adenom-Karzinom-Sequenz. Die meisten Papillenadenome treten sporadisch auf, können jedoch z.B. bei Patienten mit familiärer adenomatöser Polyposis genetisch häufiger vorkommen. Methode: Es erfolgte eine aktuelle PubMed-Recherche zum Thema endoskopische Papillenresektion. Ergebnisse/Schlussfolgerung: Eine endoskopische Papillektomie kann bei Adenomen ohne duktale Infiltration durchgeführt werden, während es in Hinblick auf das papilläre Adenokarzinom noch keinen Konsens gibt. Jedoch konnten neuere Studien zeigen, dass Patienten mit hochgradiger intraepithelialer Neoplasie der Papilla Vateri keine lymphovaskuläre Invasion oder Lymphknotenmetastasen aufweisen, sodass eine endoskopische Papillektomie gerechtfertigt erscheint. Da papilläre Adenome in bis zu 30% der Fälle das Risiko für fokale karzinomatöse Areale beherbergen können, sollte jede Papillektomie «en bloc» durchgeführt werden.

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Prophylaxis of post-ERCP pancreatitis: a practice survey

Cited by 87 publications

References 30 publications

Rectal diclofenac does not prevent post-ERCP pancreatitis in consecutive high-risk and low-risk patients

Rectal diclofenac does not prevent post-ERCP pancreatitis in consecutive high-risk and low-risk patients

Comparison between needle-knife fistulotomy and standard cannulation in ERCP

Endoskopische Papillenresektion: Indikation und Grenzen

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