The risk of post-ERCP pancreatitis and the protective effect of rectal indomethacin in cases of attempted but unsuccessful prophylactic pancreatic stent placement

Neel S. Choksi, Evan Fogel, Gregory A. Cote, Joseph Romagnuolo, Grace H. Elta, James M. Scheiman, Amitabh Chak, Patrick Mosler, Peter D R Higgins, Sheryl J. Korsnes, Suzette E. Schmidt, Stuart Sherman, Glen Lehman, B. Joseph Elmunzer

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Background It is believed, based on limited observational data, that an unsuccessful attempt to place a prophylactic pancreatic stent substantially increases the risk of post-ERCP pancreatitis (PEP). Objective To better understand the risk of PEP in patients with failed pancreatic stent placement (FPS) and the impact of rectal indomethacin on this risk. Design Secondary analysis of randomized, controlled trial data. Setting University of Michigan and Indiana University. Patients A total of 577 clinical trial participants at elevated risk for PEP. Interventions Pancreatic stent placement. Main Outcome Measurements Within the placebo group, we compared PEP rates in patients with FPS, patients who underwent successful stent placement, and in those without a stent attempt. We also performed a regression analysis evaluating the association between FPS and PEP. To define the protective effect of indomethacin, we repeated these analyses in the indomethacin group and in the full study cohort. Results The incidence of PEP among patients in the placebo group who experienced FPS was 34.7%, significantly exceeding rates in patients who underwent successful stent placement (16.4%) and in those without a stent attempt (12.1%). After we adjusted for known PEP risk factors, FPS was found to be independently associated with PEP. Among the indomethacin group and in the full cohort, FPS was not associated with a higher risk of PEP. Limitations Low event rate, FPS not prospectively captured. Conclusion FPS appears to confer an increased risk of PEP, which is attenuated by rectal indomethacin administration. These findings highlight the importance of adequate training and proficiency before endoscopists attempt pancreatic stent placement and the routine use of rectal indomethacin in high-risk ERCP cases.

Original languageEnglish
Pages (from-to)150-155
Number of pages6
JournalGastrointestinal Endoscopy
Volume81
Issue number1
DOIs
StatePublished - Jan 1 2015

Fingerprint

Endoscopic Retrograde Cholangiopancreatography
Indomethacin
Pancreatitis
Stents
Placebos
Rectal Administration

ASJC Scopus subject areas

  • Gastroenterology
  • Radiology Nuclear Medicine and imaging
  • Medicine(all)

Cite this

The risk of post-ERCP pancreatitis and the protective effect of rectal indomethacin in cases of attempted but unsuccessful prophylactic pancreatic stent placement. / Choksi, Neel S.; Fogel, Evan; Cote, Gregory A.; Romagnuolo, Joseph; Elta, Grace H.; Scheiman, James M.; Chak, Amitabh; Mosler, Patrick; Higgins, Peter D R; Korsnes, Sheryl J.; Schmidt, Suzette E.; Sherman, Stuart; Lehman, Glen; Joseph Elmunzer, B.

In: Gastrointestinal Endoscopy, Vol. 81, No. 1, 01.01.2015, p. 150-155.

Research output: Contribution to journalArticle

Choksi, NS, Fogel, E, Cote, GA, Romagnuolo, J, Elta, GH, Scheiman, JM, Chak, A, Mosler, P, Higgins, PDR, Korsnes, SJ, Schmidt, SE, Sherman, S, Lehman, G & Joseph Elmunzer, B 2015, 'The risk of post-ERCP pancreatitis and the protective effect of rectal indomethacin in cases of attempted but unsuccessful prophylactic pancreatic stent placement', Gastrointestinal Endoscopy, vol. 81, no. 1, pp. 150-155. https://doi.org/10.1016/j.gie.2014.07.033
Choksi, Neel S. ; Fogel, Evan ; Cote, Gregory A. ; Romagnuolo, Joseph ; Elta, Grace H. ; Scheiman, James M. ; Chak, Amitabh ; Mosler, Patrick ; Higgins, Peter D R ; Korsnes, Sheryl J. ; Schmidt, Suzette E. ; Sherman, Stuart ; Lehman, Glen ; Joseph Elmunzer, B. / The risk of post-ERCP pancreatitis and the protective effect of rectal indomethacin in cases of attempted but unsuccessful prophylactic pancreatic stent placement. In: Gastrointestinal Endoscopy. 2015 ; Vol. 81, No. 1. pp. 150-155.
@article{4095816d66974eb6824eb212d96cd0f4,
title = "The risk of post-ERCP pancreatitis and the protective effect of rectal indomethacin in cases of attempted but unsuccessful prophylactic pancreatic stent placement",
abstract = "Background It is believed, based on limited observational data, that an unsuccessful attempt to place a prophylactic pancreatic stent substantially increases the risk of post-ERCP pancreatitis (PEP). Objective To better understand the risk of PEP in patients with failed pancreatic stent placement (FPS) and the impact of rectal indomethacin on this risk. Design Secondary analysis of randomized, controlled trial data. Setting University of Michigan and Indiana University. Patients A total of 577 clinical trial participants at elevated risk for PEP. Interventions Pancreatic stent placement. Main Outcome Measurements Within the placebo group, we compared PEP rates in patients with FPS, patients who underwent successful stent placement, and in those without a stent attempt. We also performed a regression analysis evaluating the association between FPS and PEP. To define the protective effect of indomethacin, we repeated these analyses in the indomethacin group and in the full study cohort. Results The incidence of PEP among patients in the placebo group who experienced FPS was 34.7{\%}, significantly exceeding rates in patients who underwent successful stent placement (16.4{\%}) and in those without a stent attempt (12.1{\%}). After we adjusted for known PEP risk factors, FPS was found to be independently associated with PEP. Among the indomethacin group and in the full cohort, FPS was not associated with a higher risk of PEP. Limitations Low event rate, FPS not prospectively captured. Conclusion FPS appears to confer an increased risk of PEP, which is attenuated by rectal indomethacin administration. These findings highlight the importance of adequate training and proficiency before endoscopists attempt pancreatic stent placement and the routine use of rectal indomethacin in high-risk ERCP cases.",
author = "Choksi, {Neel S.} and Evan Fogel and Cote, {Gregory A.} and Joseph Romagnuolo and Elta, {Grace H.} and Scheiman, {James M.} and Amitabh Chak and Patrick Mosler and Higgins, {Peter D R} and Korsnes, {Sheryl J.} and Schmidt, {Suzette E.} and Stuart Sherman and Glen Lehman and {Joseph Elmunzer}, B.",
year = "2015",
month = "1",
day = "1",
doi = "10.1016/j.gie.2014.07.033",
language = "English",
volume = "81",
pages = "150--155",
journal = "Gastrointestinal Endoscopy",
issn = "0016-5107",
publisher = "Mosby Inc.",
number = "1",

}

TY - JOUR

T1 - The risk of post-ERCP pancreatitis and the protective effect of rectal indomethacin in cases of attempted but unsuccessful prophylactic pancreatic stent placement

AU - Choksi, Neel S.

AU - Fogel, Evan

AU - Cote, Gregory A.

AU - Romagnuolo, Joseph

AU - Elta, Grace H.

AU - Scheiman, James M.

AU - Chak, Amitabh

AU - Mosler, Patrick

AU - Higgins, Peter D R

AU - Korsnes, Sheryl J.

AU - Schmidt, Suzette E.

AU - Sherman, Stuart

AU - Lehman, Glen

AU - Joseph Elmunzer, B.

PY - 2015/1/1

Y1 - 2015/1/1

N2 - Background It is believed, based on limited observational data, that an unsuccessful attempt to place a prophylactic pancreatic stent substantially increases the risk of post-ERCP pancreatitis (PEP). Objective To better understand the risk of PEP in patients with failed pancreatic stent placement (FPS) and the impact of rectal indomethacin on this risk. Design Secondary analysis of randomized, controlled trial data. Setting University of Michigan and Indiana University. Patients A total of 577 clinical trial participants at elevated risk for PEP. Interventions Pancreatic stent placement. Main Outcome Measurements Within the placebo group, we compared PEP rates in patients with FPS, patients who underwent successful stent placement, and in those without a stent attempt. We also performed a regression analysis evaluating the association between FPS and PEP. To define the protective effect of indomethacin, we repeated these analyses in the indomethacin group and in the full study cohort. Results The incidence of PEP among patients in the placebo group who experienced FPS was 34.7%, significantly exceeding rates in patients who underwent successful stent placement (16.4%) and in those without a stent attempt (12.1%). After we adjusted for known PEP risk factors, FPS was found to be independently associated with PEP. Among the indomethacin group and in the full cohort, FPS was not associated with a higher risk of PEP. Limitations Low event rate, FPS not prospectively captured. Conclusion FPS appears to confer an increased risk of PEP, which is attenuated by rectal indomethacin administration. These findings highlight the importance of adequate training and proficiency before endoscopists attempt pancreatic stent placement and the routine use of rectal indomethacin in high-risk ERCP cases.

AB - Background It is believed, based on limited observational data, that an unsuccessful attempt to place a prophylactic pancreatic stent substantially increases the risk of post-ERCP pancreatitis (PEP). Objective To better understand the risk of PEP in patients with failed pancreatic stent placement (FPS) and the impact of rectal indomethacin on this risk. Design Secondary analysis of randomized, controlled trial data. Setting University of Michigan and Indiana University. Patients A total of 577 clinical trial participants at elevated risk for PEP. Interventions Pancreatic stent placement. Main Outcome Measurements Within the placebo group, we compared PEP rates in patients with FPS, patients who underwent successful stent placement, and in those without a stent attempt. We also performed a regression analysis evaluating the association between FPS and PEP. To define the protective effect of indomethacin, we repeated these analyses in the indomethacin group and in the full study cohort. Results The incidence of PEP among patients in the placebo group who experienced FPS was 34.7%, significantly exceeding rates in patients who underwent successful stent placement (16.4%) and in those without a stent attempt (12.1%). After we adjusted for known PEP risk factors, FPS was found to be independently associated with PEP. Among the indomethacin group and in the full cohort, FPS was not associated with a higher risk of PEP. Limitations Low event rate, FPS not prospectively captured. Conclusion FPS appears to confer an increased risk of PEP, which is attenuated by rectal indomethacin administration. These findings highlight the importance of adequate training and proficiency before endoscopists attempt pancreatic stent placement and the routine use of rectal indomethacin in high-risk ERCP cases.

UR - http://www.scopus.com/inward/record.url?scp=84922932631&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84922932631&partnerID=8YFLogxK

U2 - 10.1016/j.gie.2014.07.033

DO - 10.1016/j.gie.2014.07.033

M3 - Article

C2 - 25527053

AN - SCOPUS:84922932631

VL - 81

SP - 150

EP - 155

JO - Gastrointestinal Endoscopy

JF - Gastrointestinal Endoscopy

SN - 0016-5107

IS - 1

ER -