Tu1608 THE COMBINATION OF INTRAVENOUS FLUID AND INDOMETHACIN IS MORE EFFICACIOUS THAN PANCREATIC STENTS AND NSAIDS ALONE FOR THE PREVENTION OF POST-ERCP PANCREATITIS: A NETWORK META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Akshintala, Venkata S.; Weiland, Christa J. Sperna; Bhullar, Furqan A.; Kamal, Ayesha; Kanthasamy, Kavin; Kuo, Albert; Tomasetti, Cristian; Gürakar, Merve; Fan, Chenjie; Reddy, Nageshwar; Goenka, Mahesh K.; Kochhar, Rakesh; Kalloo, Anthony N.; Khashab, Mouen A.; Geenen, Erwin-Jan M. van; Singh, Vikesh K.

doi:10.1016/s0016-5085(20)33507-1

Cited by 6 publications

(9 citation statements)

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“…[2] They also report the PEP mortality rate to be 0.2% even among high-risk patients (further defined below). [2] Interestingly, it has been reported that the incidence of PEP varies based on geographic location with higher rates in North America compared to that of Europe or Asia. [3] Furthermore, it has been reported that the annual cost of PEP is $200 million for the US healthcare system.…”

Section: Introductionmentioning

confidence: 99%

“…[1] The most common complication of ERCP is post-ERCP pancreatitis (PEP) and is responsible for significant morbidity and healthcare expenditure. [2][3][4] Other less common complications include bleeding, bowel perforation, cholangitis, and acute cholecystitis. [5,6] Reported incidence rates of PEP can vary with rates as high as 40% for high-risk patients but can be significantly lower with proper patient selection.…”

Section: Introductionmentioning

confidence: 99%

“…[9] However, a more recent meta-analysis of 145 randomized controlled trials (RCT) shows the incidence of PEP to be 10.2% (95% confidence interval [CI] = 9.3–11.3) and this trend has been stable from 1977 to 2022. [2] They also report the PEP mortality rate to be 0.2% even among high-risk patients (further defined below). [2] Interestingly, it has been reported that the incidence of PEP varies based on geographic location with higher rates in North America compared to that of Europe or Asia.…”

Section: Introductionmentioning

confidence: 99%

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Post-endoscopic retrograde cholangiopancreatography pancreatitis: a review

Patel,

Akshintala

2023

Journal of Pancreatology

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Endoscopic retrograde cholangiopancreatography (ERCP) has continued to develop over recent decades with regards to both indications for its use and improvements in technique. The most common complication is post- endoscopic retrograde cholangiopancreatography pancreatitis (PEP) with incidence rates being reported at ~10%. The exact mechanism of PEP is unknown but is likely multi-factorial with papillary edema contributing to the activation of the inflammatory cascade playing an important role. Selected risk factors include patient-related factors (female, sex, younger age, sphincter of Oddi dysfunction, and history of PEP) and procedure-related factors (difficult cannulation, multiple pancreatic duct guidewire passes, pancreatic acinarization, multiple pancreatic duct contrast injections and precut sphincterotomy). Several preventative prophylactic strategies have been posited; however, current guidelines recommend the use of rectal NSAIDs, aggressive IV fluid hydration and pancreatic duct stents. Appropriate patient selection and the use of non-invasive imaging modalities for diagnosis of pancreaticobiliary abnormalities is a key aspect in prevention. Future studies continue to explore various pharmacologic, procedure-related and combination strategies for prevention and will be important as the use of ERCP continues to grow.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Post-endoscopic retrograde cholangiopancreatography pancreatitis: a review

Patel,

Akshintala

2023

Journal of Pancreatology

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“…1 Endoscopic retrograde cholangiopancreatography (ERCP) is recommended as the standard treatment regardless of the presence or absence of symptoms. [2][3][4] The incidence of ERCP-related adverse events (AEs) has been reported as approximately 10% 5,6 ; however, in previous studies, asymptomatic CBDS in patients with normal anatomy and Billroth-I (B-I) reconstruction has been reported to be associated with a high rate of ERCP-related AEs (15.6%-26.9%) compared to symptomatic CBDS (with symptoms including abdominal pain and liver dysfunction). [7][8][9][10] The studies also reported that the incidence of post-ERCP pancreatitis (PEP) was particularly high at 12.5%-20.8%.…”

Section: Introductionmentioning

confidence: 99%

Balloon enteroscopy‐assisted endoscopic retrograde cholangiopancreatography for asymptomatic common bile duct stones on surgically altered anatomy: A high risk factor for post‐endoscopic retrograde cholangiopancreatography pancreatitis

Watanabe,

Okuwaki,

Iwai

et al. 2023

J Hepato Biliary Pancreat

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BackgroundPost‐endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is more common in patients with asymptomatic common bile duct stones (CBDSs) and normal anatomy than in those with symptomatic CBDS; however, studies on the effect of surgically altered anatomy are lacking. We aimed to investigate whether asymptomatic CBDS in balloon enteroscopy‐assisted ERCP cases for surgically altered anatomy also has a high incidence of PEP and analyze the risk factors for PEP.MethodsWe retrospectively analyzed 108 consecutive patients who underwent initial ERCP for CBDS with surgically altered anatomies and with naive papilla at Kitasato University Hospital from April 2015 to December 2022.ResultsStudy participants were as follows: 92 (85%) patients with symptomatic CBDS and 16 (15%) patients asymptomatic CBDS. The overall bile duct cannulation success rate was 89.8%, with PEP occurring in 7.4% of patients (symptomatic CBDS: 3.3%, asymptomatic CBDS: 31.3%). PEP incidence was significantly higher for asymptomatic CBDS (p = .0017). Multivariate analysis identified asymptomatic CBDS and precut sphincterotomy as significant risk factors for PEP.ConclusionsAsymptomatic CBDS may be a risk factor for PEP onset in balloon enteroscopy‐assisted ERCP with surgically altered anatomy. Therefore, the procedure should be performed after obtaining sufficient informed consent and adequate preparation.

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“…La tasa de pancreatitis en el grupo placebo fue de 12.3%. De acuerdo con una escala de desempeño, la combinación de SS + IR tuvo la mayor probabilidad de ser considerada la mejor intervención profiláctica; superior a antiinflamatorios solos, prótesis pancreática u otras combinaciones 13 .…”

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Calidad en Colangiografía endoscópica

López‐Colombo¹

2020

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Tu1608 THE COMBINATION OF INTRAVENOUS FLUID AND INDOMETHACIN IS MORE EFFICACIOUS THAN PANCREATIC STENTS AND NSAIDS ALONE FOR THE PREVENTION OF POST-ERCP PANCREATITIS: A NETWORK META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Cited by 6 publications

References 0 publications

Post-endoscopic retrograde cholangiopancreatography pancreatitis: a review

Post-endoscopic retrograde cholangiopancreatography pancreatitis: a review

Balloon enteroscopy‐assisted endoscopic retrograde cholangiopancreatography for asymptomatic common bile duct stones on surgically altered anatomy: A high risk factor for post‐endoscopic retrograde cholangiopancreatography pancreatitis

Calidad en Colangiografía endoscópica

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