CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(07): E986-E988
DOI: 10.1055/a-1399-8891

Underutilization of societal guidelines: occasional or widespread?

Richard Kozarek
Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington, United States
› Author Affiliations

The current publication by Issak et al, “Prophylactic rectal indomethacin and pancreatic duct stents (PPS) for prevention of post-ERCP pancreatitis (PEP) are underutilized in average and high-risk patients undergoing ERCP” [1], reviews 31,050 adults captured by the IBM Explorys database between 2014 and 2019. Patients were categorized by risk factors for PEP, which included female sex, age < 40 years, sphincter of Oddi dysfunction, history of acute pancreatitis, or pancreatic sphincterotomy at time of the procedure [2]. Average-risk patients had no risk factors, and patients were stratified for 0 to ≥ 3 risk factors. The database did not allow retrieval of other procedural risk factors for PEP to include multiple cannulation attempts, multiple pancreatic duct injections, pancreatic acinarization with contrast injection, or failure to use guidewire cannulation to selectively access the biliary tree; nor did it define the ERCP experience of the endoscopist or whether a trainee was involved in the procedure. The primary outcome of the study was to define the incidence of nonsteroidal anti-inflammatory drug (NSAID) or pancreatic stent use in an attempt to decrease PEP. Secondary outcomes were prophylaxis for and incidence of PEP contingent upon number of risk factors. Not surprising was that as the number of risk factors increased, so too did PEP. What perhaps was surprising in this study was that only one-third of all patients undergoing ERCP received PEP prophylaxis. This included 82.4 % receiving rectal indomethacin and 12.4 % who had placement of a prophylactic pancreatic stent (PPS).

Publication History

Publication Date:
17 June 2021 (online)

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