Mo1407 Post ERCP Complications: Comparing Standard Biliary Cannulation With Needle Knife Fistulotomy

Abstract

Mo1406 Pancreatic Duct Stenting for the Prevention of Post-ERCP Pancreatitis: National Trends Mohammad H. Shakhatreh*, Somashekar G. Krishna, Jeffery R. Groce, Sheetal Sharma, Jon P. Walker, Alice Hinton, Samer El-Dika Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH; Division of Biostatistics, School of Public Health, The Ohio State University, Columbus, OH Introduction: Studies have emerged to support the use of prophylactic pancreatic duct (PD) stent placement for the prevention of post-ERCP pancreatitis. Patients with choledocholithiasis do not usually have a PD stent placed during ERCP unless it is for the sole purpose of preventing post-ERCP pancreatitis. The aim of the present study was to evaluate the effect these studies have had on national trends in prophylactic PD stent placement. Methods: Using the Nationwide Inpatient Sample from 2003 to 2011, we retrospectively collected data on inpatients undergoing ERCP for choledocholithiasis. We analyzed the overall number of ERCPs and the number done when a PD stent was placed and evaluated the trend of utilization during the study period. We also evaluated the demographics and hospital characteristics for these patients. Results: During the study period, the number of admissions for choledocholithiasis increased from 112,675 (0.29% of all admissions) in 2003 to 149,271 (0.39% of all admissions) in 2011 (p!0.0001) (Figure 1). There was a decrease in the proportion of inpatient ERCPs among patients admitted with choledocholithiasis from 67.0% in 2003 to 62.8% in 2007, but then this gradually increased to 65.6% in 2011 (Figure 1). During the same study period, an increase in the use of pancreatic duct stenting was noted, starting in 2005 and peaking at 3.6% in 2010 (Figure 1). The mean age of patients who underwent ERCP with PD stent placement was 56.8 years (95%CI 55.9-57.7). Most PD stents were placed in women (64.8%) and in Whites (68.8%). The use of PD stents was more common in urban teaching hospitals (51.8%) and large size hospitals (67.5%). Most patients who underwent placement of a PD stent had an Elixhauser comorbidity index of less than 3 (64.2%). Conclusion: Despite the decline in the proportion of inpatient ERCPs among patients admitted with choledocholithiasis between 2003 and 2011, the use of PD stenting has significantly increased, especially since 2005, after multiple studies were published reporting decreased rates of post-ERCP pancreatitis with the use of prophylactic PD stents.