Evaluation of pancreatic stent and/or suppository indomethacin efficacy in post ERCP pancreatitis prophylaxis: a single center experience

Yıl 2023, Cilt: 6 Sayı: 2, 374 - 379, 27.03.2023

Çağdaş Erdoğan , İbrahim Ethem Güven , Batuhan Başpınar , Zeki Mesut Yalın Kılıç

https://doi.org/10.32322/jhsm.1197804

Öz

Aim: Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is a serious complication of ERCP. In this study, we aimed to compare the use of rectal indomethacin, pancreatic stenting or both techniques for prevention of PEP.
Material and Method: Patients who underwent ERCP for the first time due to choledocholithiasis between January 2022 and June 2022 were retrospectively reviewed. The clinical findings, demographics, laboratory records, endoscopic intervention characteristics, whether rectal indomethacin was applied before the procedure, whether pancreatic stent was placed or not were evaluated.
Results: A total of 367 patients who underwent ERCP for the first time were included in the study. The mean age was 61 (28-92) years and 53.4% were female. In 124 (33.8%) patients, involuntary guide-wire insertion into the pancreatic duct occurred during canulation. Pancreatic stent was placed in 82 (22.3%) of the patients. Rectal indomethacin was administered to 288 patients (78.5%), while indomethacin could not be administered in 79 patients (21.5%), because they did not give consent. When patients with involuntarily pancreatic canulation were evaluated, the rate of PEP was 3.6% in the stented group, while it was 15.3% in the stent-free group (p<0001). The incidence of PEP was 20.3% in 79 patients who could not be administered rectal indomethacin, while this rate was 3.1% in those who received rectal indomethacin (p<0001).
Conclusion: The first and most important way to prevent PEP is to avoid unnecessary ERCPs. Rectal indomethacin administration reduces the risk of PEP. All patients with involuntary wires in the pancreatic duct, should be evaluated for pancreatic stent placement.

Anahtar Kelimeler

Post-ERCP pancreatitis, rectal indomethacin, pancreatic stent, prophlaxis

Kaynakça

• 1. Peery AF, Crockett SD, Barritt AS, et al. Burden of Gastrointestinal, Liver, and Pancreatic Diseases in the United States. Gastroenterology 2015; 149:1731.
• 2. TORVIK A, HOIVIK B. Gallstones in an autopsy series. Incidence, complications, and correlations with carcinoma of the gallbladder. Acta Chir Scand 1960; 120:168.
• 3. Zahor A, Sternby NH, Kagan A, et al. Frequency of cholelithiasis in Prague and Malmö. An autopsy study. Scand J Gastroenterol 1974; 9:3.
• 4. Brett M, Barker DJ. The world distribution of gallstones. Int J Epidemiol 1976; 5:335.
• 5. Collins C, Maguire D, Ireland A, et al. A prospective study of common bile duct calculi in patients undergoing laparoscopic cholecystectomy: natural history of choledocholithiasis revisited. Ann Surg 2004; 239:28.
• 6. Hunter JG. Laparoscopic transcystic common bile duct exploration. Am J Surg 1992; 163:53.
• 7. Prat F, Amouyal G, Amouyal P, et al. Prospective controlled study of endoscopic ultrasonography and endoscopic retrograde cholangiography in patients with suspected common-bileduct lithiasis. Lancet 1996; 347:75.
• 8. Gurusamy KS, Giljaca V, Takwoingi Y, et al. Endoscopic retrograde cholangiopancreatography versus intraoperative cholangiography for diagnosis of common bile duct stones. Cochrane Database Syst Rev 2015; :CD010339.
• 9. Siiki A, Tamminen A, Tomminen T, Kuusanmäki P. ERCP procedures in a Finnish community hospital: a retrospective analysis of 1207 cases. Scand J Surg 2012; 101:45.
• 10. Kapral C, Mühlberger A, Wewalka F, et al. Quality assessment of endoscopic retrograde cholangiopancreatography: results of a running nationwide Austrian benchmarking project after 5 years of implementation. Eur J Gastroenterol Hepatol 2012; 24:1447.
• 11. Kienbauer M, Duller C, Gschwantler M, et al. [Austrian benchmarking project for ERCP: a 10-year report]. Z Gastroenterol 2018; 56:1227.
• 12. Glomsaker T, Hoff G, Kvaløy JT, et al. Patterns and predictive factors of complications after endoscopic retrograde cholangiopancreatography. Br J Surg 2013; 100:373.
• 13. Andriulli A, Loperfido S, Napolitano G, et al. Incidence rates of post-ERCP complications: a systematic survey of prospective studies. Am J Gastroenterol 2007; 102:1781.
• 14. Dumonceau JM, Kapral C, Aabakken L, et al. ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2020; 52:127.
• 15. Kochar B, Akshintala VS, Afghani E, et al. Incidence, severity, and mortality of post-ERCP pancreatitis: a systematic review by using randomized, controlled trials. Gastrointest Endosc 2015; 81:143.
• 16. Morales SJ, Sampath K, Gardner TB. A Review of Prevention of Post-ERCP Pancreatitis. Gastroenterol Hepatol (N Y) 2018; 14:286.
• 17. ASGE Standards of Practice Committee, Chandrasekhara V, Khashab MA, et al. Adverse events associated with ERCP. Gastrointest Endosc 2017; 85:32.
• 18. Phillip, V., Pukitis, A., Epstein, A., Hapfelmeier, A., Haf, D., Schwab, M., Demir, I. E., Rosendahl, J., Hoffmeister, A., Schmid, R. M., Weber, A., & Algül, H. (2019). Pancreatic stenting to prevent post-ERCP pancreatitis: a randomized multicenter trial. Endoscopy international open, 7(7), E860–E868. https://doi.org/10.1055/a-0886-6384
• 19. Pekgöz M. Post-endoscopic retrograde cholangiopancreatography pancreatitis: A systematic review for prevention and treatment. World J Gastroenterol. 2019;25(29):4019-4042. doi:10.3748/wjg.v25.i29.4019
• 20. Masci, E., Mariani, A., Curioni, S., & Testoni, P. A. (2003). Risk factors for pancreatitis following endoscopic retrograde cholangiopancreatography: a meta-analysis. Endoscopy, 35(10), 830–834. https://doi.org/10.1055/s-2003-42614
• 21. Harewood, G. C., Pochron, N. L., & Gostout, C. J. (2005). Prospective, randomized, controlled trial of prophylactic pancreatic stent placement for endoscopic snare excision of the duodenal ampulla. Gastrointestinal endoscopy, 62(3), 367–370. https://doi.org/10.1016/j.gie.2005.04.020
• 22. Döbrönte, Z., Toldy, E., Márk, L., Sarang, K., & Lakner, L. (2012). Az indometacin szerepe az endoszkópos retrográd cholangiopancreatographiát követő akut pancreatitis prevenciójában [Effects of rectal indomethacin in the prevention of post-ERCP acute pancreatitis]. Orvosi hetilap, 153(25), 990–996. https://doi.org/10.1556/OH.2012.29403
• 23. Elmunzer, B. J., Scheiman, J. M., Lehman, G. A., Chak, A., Mosler, P., Higgins, P. D., Hayward, R. A., Romagnuolo, J., Elta, G. H., Sherman, S., Waljee, A. K., Repaka, A., Atkinson, M. R., Cote, G. A., Kwon, R. S., McHenry, L., Piraka, C. R., Wamsteker, E. J., Watkins, J. L., Korsnes, S. J., … U.S. Cooperative for Outcomes Research in Endoscopy (USCORE) (2012). A randomized trial of rectal indomethacin to prevent post-ERCP pancreatitis. The New England journal of medicine, 366(15), 1414–1422. https://doi.org/10.1056/NEJMoa1111103
• 24. Yaghoobi, M., Rolland, S., Waschke, K. A., McNabb-Baltar, J., Martel, M., Bijarchi, R., Szego, P., & Barkun, A. N. (2013). Meta-analysis: rectal indomethacin for the prevention of post-ERCP pancreatitis. Alimentary pharmacology & therapeutics, 38(9), 995–1001. https://doi.org/10.1111/apt.12488