Risk factors for post-ERCP pancreatitis: a systematic review of clinical trials with a large sample size in the past 10 years

Chen, Jianjun; Wang, Ximo; Liu, Xingqiang; Wen, Li; Dong, Min; Suo, Zong-Wu; Ding, Po; Li, Yue

doi:10.1186/2047-783x-19-26

Cited by 101 publications

(72 citation statements)

References 30 publications

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“…PEP is associated with higher morbidity and mortality beside its effect in increasing the consumption of hospital resources[11]. Identification of clinical and procedural correlates for PEP is of crucial importance in the practice of ERCP.…”

Section: Discussionmentioning

confidence: 99%

Post-endoscopic retrograde cholangiopancreatography pancreatitis: Risk factors and predictors of severity

Nakeeb

Hanafy

Salah

et al. 2016

WJGE

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AIMTo detect risk factors for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) and investigate the predictors of its severity.METHODSThis is a prospective cohort study of all patients who underwent ERCP. Pre-ERCP data, intraoperative data, and post-ERCP data were collected.RESULTSThe study population consisted of 996 patients. Their mean age at presentation was 58.42 (± 14.72) years, and there were 454 male and 442 female patients. Overall, PEP occurred in 102 (10.2%) patients of the study population; eighty (78.4%) cases were of mild to moderate degree, while severe pancreatitis occurred in 22 (21.6%) patients. No hospital mortality was reported for any of PEP patients during the study duration. Age less than 35 years (P = 0.001, OR = 0.035), narrower common bile duct (CBD) diameter (P = 0.0001) and increased number of pancreatic cannulations (P = 0.0001) were independent risk factors for the occurrence of PEP.CONCLUSIONPEP is the most frequent and devastating complication after ERCP. Age less than 35 years, narrower median CBD diameter and increased number of pancreatic cannulations are independent risk factors for the occurrence of PEP. Patients with these risk factors are candidates for prophylactic and preventive measures against PEP.

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Section: Discussionmentioning

confidence: 99%

Post-endoscopic retrograde cholangiopancreatography pancreatitis: Risk factors and predictors of severity

Nakeeb

Hanafy

Salah

et al. 2016

WJGE

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“…Exploratory subgroup analysis by calculating relative risks was performed for pre-specified factors which conveyed a higher risk for PEP - pancreatic stent placement, suspected sphincter of Oddi dysfunction, history of PEP, difficult cannulation, wire cannulation of the pancreatic duct, pancreatography, pancreatic acinarization, therapeutic biliary sphincterotomy, therapeutic pancreatic sphincterotomy, balloon dilation of the biliary sphincter, and trainee involvement in the ERCP. 13 …”

Section: Methodsmentioning

confidence: 99%

Rectal Indomethacin Does Not Prevent Post-ERCP Pancreatitis in Consecutive Patients

et al. 2016

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Background & Aims Rectal indomethacin, a non-steroidal anti-inflammatory drug, is given to prevent pancreatitis in high-risk patients undergoing endoscopic retrograde cholangiopancreatography (ERCP), based on findings from clinical trials. European Society for Gastrointestinal Endoscopy guidelines recently recommended prophylactic rectal indomethacin for all patients undergoing ERCP, including those at average risk for pancreatitis. We performed a randomized controlled trail to investigate the efficacy of this approach. Methods We performed a prospective, double-blind, placebo-controlled trial of 449 consecutive patients undergoing ERCP at Dartmouth Hitchcock Medical Center, from March 2013 through December 2014. Approximately 70% of the cohort were at average-risk for PEP. Subjects were randomly assigned to groups given either a single 100 mg dose of rectal indomethacin (n=223) or a placebo suppository (n=226) during the procedure. The primary outcome was the development of post-ERCP pancreatitis (PEP), defined by new upper-abdominal pain, a level of lipase greater than 3-fold the upper limit of normal, and hospitalization following ERCP for 2 consecutive nights. Results There were no differences between the groups in baseline clinical or procedural characteristics. Sixteen patients in the indomethacin group (7.2%) and 11 in the placebo group (4.9%) developed PEP (P=.33). Complications and the severity of PEP were similar between groups. Per a priori protocol guidelines, the study was stopped due to futility. Conclusions In a randomized controlled study of consecutive patients undergoing ERCP, rectal indomethacin did not prevent post-ERCP pancreatitis. ClincialTrials.gov no: NCT01774604

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“…They reported that pancreatic injection (OR 2.2, 95% CI 1.6-3.01, p < 0.001) was one of the risk factors for PEP as an endoscopy-related factor. In addition, procedures associated with difficult selective cannulation have been confirmed as risk factors for PEP in other studies [20,21]. Further, various efforts to prevent PEP have been reported.…”

Section: Discussionmentioning

confidence: 78%

Can Iodixanol Prevent Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis? A Prospective, Randomized, Controlled Trial

Ogura

Imoto

Okuda

et al. 2019

Dig Dis

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Background: It is yet not clear whether differences in the contrast medium may affect post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). Aim: The aim of this study was to evaluate the rate of PEP between high osmolality contrast medium (HOCM) and iso osmolar medium (IOCM) in a prospective, randomized, controlled trial. Methods: Patients who were scheduled to undergo a diagnostic or therapeutic procedure under ERCP guidance were included. Patients were excluded from this study if they (1) were < 20 years old; (2) had acute or active pancreatitis; (3) had previously undergone ERCP; (4) had surgical altered upper gastrointestinal tract anatomy; or (5) refused to be involved in this study. Results: Seventy-five patients were randomly assigned to the IOCM group, and 71 patients were assigned to the HOCM group. PEP occurred in 27 patients (18.5%). Although there were no significant differences, the severe grade of PEP was more frequent in the HOCM group than in the IOCM group (p = 0.08). The results of the multivariate analyses for PEP were not identified as independent risk factors. Also, independent risk factors of hyperamylasemia were performing pre-cut. In subgroup analyses, HOCM was an independent risk factor for hyperamylasemia. Conclusions: In conclusion, HOCM may play a role in the development of PEP and in PEP severity grade.

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Risk factors for post-ERCP pancreatitis: a systematic review of clinical trials with a large sample size in the past 10 years

Cited by 101 publications

References 30 publications

Post-endoscopic retrograde cholangiopancreatography pancreatitis: Risk factors and predictors of severity

Post-endoscopic retrograde cholangiopancreatography pancreatitis: Risk factors and predictors of severity

Rectal Indomethacin Does Not Prevent Post-ERCP Pancreatitis in Consecutive Patients

Can Iodixanol Prevent Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis? A Prospective, Randomized, Controlled Trial

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