BIG MEETING - BRITISH and IRISH Gastroenterology

2nd Poster Prize BIG 2017

Michael Killian
Bon Secours Hospital, Cork

Poster (17BIG224)

Rectal NSAIDs and selective pancreatic stenting significantly reduces acute pancreatitis in normal risk ERCP

Author(s)

Michael Killian1,2, Samet Maxudor1 Mary Looby1 Debrenn O’ Connor1 William Stack1,2

Department(s)/Institutions

Department of Gastroenterology, Bon Secours Hospital, College Road, Cork1 Department of Medicine, University College Cork2

Introduction

In high-risk cases a combination of NSAIDs and selective pancreatic stenting may reduce the risk of post ERCP pancreatitis (PEP). However, studies on whether this practice reduces PEP in normal risk ERCPs have shown conflicting results.

 

Aims/Background

To compare the rate of PEP for normal risk ERCP, where patients are administered rectal NSAIDs immediately following the procedure with selective pancreatic stenting (N/S), against the previous practice, which did not incorporate N/S.

Method

Consecutive ERCPs from 2009-2016 were analysed pre and post N/S. In the post N/S group rectal NSAIDS were administered immediately following the procedure. Pancreatic stents were used if the pancreatic duct was cannulated more than three times during the procedure. PEP was defined as post ERCP abdominal pain and a rise in amylase to at least twice the upper limit of normal. Statistical analysis was by paired t and McNemars tests.

Results

574 ERCP procedures were performed, of which 509 were successful (89%). 335 (58%) were female, with an average age of 67.7 (range16-94 years). 488 were therapeutic (96%). There were no statistically significant differences in the demographics of each group. 23 of 375 (6.1%) in the Pre N/S group developed PEP compared to 4 of 199 (2%) in the Post N/S group, p=0.02.

Conclusions

This study shows a further significant reduction of PEP in normal risk ERCP in a cohort of patients with a historically low PEP rate following the introduction of rectal NSAIDs and selective pancreatic stenting.