15 Utilization Patterns of Prophylactic Pancreatic Stents for the Prevention of Post-ERCP Pancreatitis: A 2018 National Survey Study

Abstract

INTRODUCTION: Post ERCP Pancreatitis (PEP) is the most frequent complication of endoscopic retrograde cholangiopancreatography (ERCP). Prophylactic pancreatic stents (PPS) and rectal indomethacin (IND) prevent PEP, decrease severity in PEP and are endorsed by GI societies. It is unclear the extent to which these interventions are practiced throughout the United States (US). The impact of such factors as training, experience and practice setting on the use of PPS for PEP prophylaxis is unclear. The aims of our study are to describe utilization patterns and identify factors that impact physician decisions to use PPS for PEP prophylaxis. METHODS: A 27-question electronic survey was distributed using a cloud based program (Qualtrics). Questions assessed ERCP training, practice setting, experience, practice patterns and perceptions for PEP prophylaxis interventions. Endoscopists with practices based in the US, listed in the American Society for Gastrointestinal Endoscopy (ASGE) 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 was de-identified for the purposes of analysis. RESULTS: Of survey respondents (n = 319/6276), 46% reported therapeutic endoscopy fellowship training and 37% practiced in teaching programs (Table 1). Annualized ERCP volume of >100 cases per year were reported by 47%, with pancreatic ERCP comprising ≤5% of procedures in the majority of respondents (61%). The majority of respondents utilized PPS and 54% reported frequent use (Table 2). The most common indications for PPS were: difficult cannulation, to assist biliary access and multiple pancreatic duct injections. The majority of respondents reported frequent use of IND (89%). Of physicians that do not use PPS, use of IND was the most common reason (80%). Variables associated with frequent use of PPS were therapeutic fellowship training (P = <0.001), practice at a teaching program (P = <0.001), <10 yrs in practice (P = 0.005), higher procedure volume (P = <0.001), higher proportion of pancreatic cases (P = <0.001), and selective use of IND (P = 0.002) (Table 3). CONCLUSION: Physicians with higher volume, teaching hospital based ERCP practices and regularly perform pancreatic ERCP are more likely to use PPS. Therapeutic fellowship training and recent entry into practice also associate with PPS utilization. Indomethacin use was prevalent and the most cited reason for electing not to use PPS.