Clin Endosc.  2020 Jan;53(1):73-81. 10.5946/ce.2019.052.

Practice Patterns and Use of Endoscopic Retrograde Cholangiopancreatography in the Management of Recurrent Acute Pancreatitis

• Reichstein JB
• Patel V
• Mekaroonkamol P
• Dacha S
• Keilin SA
• Cai Q
• Willingham FF

• KMID: 2500908
• DOI: http://doi.org/10.5946/ce.2019.052

Abstract

Background/Aims
There are conflicting opinions regarding the management of recurrent acute pancreatitis (RAP). While some physicians recommend endoscopic retrograde cholangiopancreatography (ERCP) in this setting, others consider it to be contraindicated in patients with RAP. The aim of this study was to assess the practice patterns and clinical features influencing the management of RAP in the US.
Methods
An anonymous 35-question survey instrument was developed and refined through multiple iterations, and its use was approved by our Institutional Review Board. The survey was distributed via email to 408 gastroenterologists to assess the practice patterns in the management of RAP in multiple clinical scenarios.
Results
The survey was completed by 65 participants representing 36 of the top academic/tertiary care centers across the country. Approximately 90.8% of the participants indicated that they might offer or recommend ERCP in the management of RAP. Multinomial logistic regression analysis revealed that ductal dilatation and presence of symptoms were the most predictive variables (p<0.001) for offering ERCP.
Conclusions
A preponderance of the respondents would consider ERCP among patients with RAP presenting to tertiary care centers in the US. Ductal dilatation, presence of symptoms, and pancreas divisum significantly increased the likelihood of a recommendation for ERCP

Keyword

Recurrent acute pancreatitis; Endoscopic retrograde cholangiopancreatography; Practice patterns; Pancreas divisum

Figure

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  Fig. 1. Proportion of respondents who would offer endoscopic retrograde cholangiopancreatography (ERCP) considering different factors. The more factors a patient had—including the presence of pancreatic ductal dilatation (e.g., 6 mm), a history of pancreas divisum, and the presence of pancreatic-type pain—the higher the response rate for ERCP.

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  Fig. 2. Graphical representation of the multinomial logistic regression testing assessing the impact of several clinical features on the recommendation to offer endoscopic retrograde cholangiopancreatography (ERCP) in patients with recurrent acute pancreatitis. Pancreatic ductal dilatation appeared to be the single most impactful factor, followed by symptomatology. PD, pancreatic duct.

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