Department of Gastroenterology and Hepatology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
Department of Statistics and Data Science, The University of Texas at Austin, Austin, Texas, USA.
Gastrointest Endosc. 2023 Jun;97(6):1059-1066.e3. doi: 10.1016/j.gie.2023.01.049. Epub 2023 Feb 3.
Post-ERCP pancreatitis (PEP) is the most frequent adverse event of ERCP. Various prophylactic measures are endorsed by the American Society for Gastrointestinal Endoscopy and the European Society of Gastrointestinal Endoscopy to both lower the incidence of PEP and to decrease its severity. The extent to which these interventions are practiced throughout the United States is unclear. The aim of this study was to describe the utilization pattern of various PEP measures and determine factors that affect utilization of these measures.
A 27-question electronic survey was distributed using a cloud-based program (Qualtrics). The questions assessed ERCP training, practice setting, experience, practice patterns, and perceptions for PEP prophylaxis interventions. Endoscopists with practices based in the United States listed in the American Society for Gastrointestinal Endoscopy member directory received a survey invitation via e-mail. The invitation outlined the study and contained a link with instructions to complete the voluntary survey if they had an active ERCP practice. Data were de-identified for the purposes of analysis.
Of survey respondents (N = 319), 46% reported therapeutic endoscopy fellowship training and 37% practiced in teaching programs. Annualized ERCP volume of >100 cases per year were reported by 47%, with pancreatic ERCP comprising ≤5% of procedure volume reported by the majority of respondents (61%). The majority of respondents used prophylactic pancreatic stent (PPS), and 54% reported frequent use during high-risk ERCP. The most common indications for PPS were difficult cannulation, to assist biliary access, and multiple pancreatic duct injections. Most respondents reported frequent use of indomethacin (89%). Of physicians who did not use PPS, use of indomethacin was the most common reason (80%). Variables associated with frequent use of PPS were ERCP fellowship training (P ≤ .001), practice at a teaching program (P ≤ .001), <10 years in practice (P = .005), higher procedure volume (P ≤ .001), and higher proportion of pancreatic cases (P ≤ .001).
Physicians with higher annual ERCP volume, who teach at hospital-based ERCP practices, and who regularly perform pancreatic ERCP are more likely to use PPS. Therapeutic ERCP fellowship training and recent entry into practice were also associated with PPS utilization. Indomethacin use seems to be more frequent than PPS. Our findings suggest that indomethacin is supplanting PPS as the preferred method of PEP prophylaxis.
内镜逆行胰胆管造影（ERCP）后胰腺炎（PEP）是 ERCP 最常见的不良事件。美国胃肠内镜学会和欧洲胃肠内镜学会均推荐多种预防措施，以降低 PEP 的发生率和严重程度。但目前尚不清楚这些干预措施在美国的实施程度。本研究旨在描述各种 PEP 预防措施的应用模式，并确定影响这些措施应用的因素。
采用基于云的程序（Qualtrics）分发了一份包含 27 个问题的电子调查问卷。这些问题评估了 ERCP 培训、实践环境、经验、实践模式和对 PEP 预防干预措施的看法。在美国胃肠内镜学会会员名录中有执业地点的内镜医师会收到电子邮件形式的调查邀请。邀请概述了该研究，并提供了一个链接，以供他们在进行积极的 ERCP 实践时完成自愿调查。为了分析目的，数据是去识别的。
在接受调查的 319 名受访者中，46%的人报告接受过治疗性内镜 fellowship培训，37%的人在教学项目中执业。47%的人报告每年进行超过 100 例 ERCP，大多数受访者（61%）报告胰腺 ERCP 占其手术量的≤5%。大多数受访者使用预防性胰管支架（PPS），54%的人在高危 ERCP 时频繁使用。PPS 的最常见适应证为困难插管、辅助胆管进入和多次胰管注射。大多数受访者经常使用吲哚美辛（89%）。不使用 PPS 的医生中，最常见的原因是使用吲哚美辛（80%）。与频繁使用 PPS 相关的变量包括 ERCP fellowship培训（P≤.001）、在教学医院执业（P≤.001）、实践年限<10 年（P=0.005）、手术量较高（P≤.001）和胰腺手术比例较高（P≤.001）。
每年进行更高数量 ERCP、在以医院为基础的 ERCP 实践中教学的医生，以及经常进行胰腺 ERCP 的医生更有可能使用 PPS。治疗性 ERCP fellowship培训和近期开始执业也与 PPS 的使用有关。吲哚美辛的使用似乎比 PPS 更为频繁。我们的研究结果表明，吲哚美辛正在取代 PPS，成为 PEP 预防的首选方法。
