CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(07): E979-E985
DOI: 10.1055/a-1460-7776
Original article

Underutilization of prophylactic rectal indomethacin and pancreatic duct stent for prevention of post-ERCP Pancreatitis

Abdulfatah Issak
1  Division of Gastroenterology and Hepatology, Metrohealth Medical Center, Case Western Reserve University, Cleveland, Ohio, United States
2  Department of Internal Medicine, Metrohealth Medical Center, Case Western Reserve University, Cleveland, Ohio, United States
,
Abbinaya Elangovan
1  Division of Gastroenterology and Hepatology, Metrohealth Medical Center, Case Western Reserve University, Cleveland, Ohio, United States
2  Department of Internal Medicine, Metrohealth Medical Center, Case Western Reserve University, Cleveland, Ohio, United States
,
Roy D. Ferguson
1  Division of Gastroenterology and Hepatology, Metrohealth Medical Center, Case Western Reserve University, Cleveland, Ohio, United States
2  Department of Internal Medicine, Metrohealth Medical Center, Case Western Reserve University, Cleveland, Ohio, United States
,
Nisheet Waghray
1  Division of Gastroenterology and Hepatology, Metrohealth Medical Center, Case Western Reserve University, Cleveland, Ohio, United States
2  Department of Internal Medicine, Metrohealth Medical Center, Case Western Reserve University, Cleveland, Ohio, United States
,
Dalbir S. Sandhu
3  Division of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, United States
› Author Affiliations

Abstract

Background and study aims Incidence of Post-ERCP pancreatitis (PEP) ranges from 1 % to 10 % in unselected patients and as high as 25 % to 30 % in high-risk patients. Rectal indomethacin administered before or immediately after an ERCP and prophylactic pancreatic duct stent placement (PPS) are associated with a reduction in the incidence of PEP. We sought to investigate the utilization rate for prophylactic rectal indomethacin and PPS in average and high-risk patients undergoing ERCP between 2014 and 2019.

Patients and methods We performed a retrospective analysis in the IBM Explorys database, a pooled, national de-identified clinical database of over 72 million unique patients from 26 health care networks and 300 hospitals across the United States from 2014 to 2019. Average and high-risk patients undergoing ERCP were identified using Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) diagnosis codes. PEP was defined by the presence of SNOMED CT diagnosis of acute pancreatitis and an inpatient admission within 5 days of an ERCP procedure.

Results Out of 31,050 adults who had undergone ERCP from 2014 to 2019, only 10,500 individuals (33.8 %) had a PEP prophylaxis. Rectal indomethacin and PPS accounted for 82.4 % and 12.9 % respectively. Individuals with three risk factors had the highest PEP rates followed by individuals with two risk factors.

Conclusions Only one-third of all patients undergoing ERCP received prophylaxis in the form of rectal indothemacin and/or PPS in this large population-based data. Increased implementation of prophylactic use is needed in patients undergoing ERCP as supported by current guidelines.



Publication History

Received: 24 September 2020

Accepted: 23 February 2021

Publication Date:
17 June 2021 (online)

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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