Pharmacological and Endoscopic Interventions for Prophylaxis of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis

Background: Post-endoscopic retrograde cholangiopancreatogra-phy pancreatitis (PEP) represents the most common serious com-plication after endoscopic retrograde cholangiopancreatography (ERCP). Rectal non-steroidal anti-inflammatory drugs (NSAIDs) and pancreatic duct stenting (PDS) are the prophylactic interven-tions with more evidence and efficacy; however, PEP still represents a significant source of morbidity, mortality, and economic burden. Chronic statin use has been proposed as a prophylactic method that could be cheap and relatively safe. However, the evidence is conflict-ing. We aimed to evaluate the impact of endoscopic and pharmaco-logical interventions including chronic statin and aspirin use, on the development of PEP.Methods: A retrospective cohort study evaluated consecutive patients undergoing ERCP at John H. Stroger, Jr. Hospital of Cook County in Chicago from January 2015 to March 2018. Univariate and multivari-ate analyses were performed using logistic regression.Results: A total of 681 ERCPs were included in the study. Twelve (1.76%) developed PEP. Univariate, multivariate, and subgroup anal-yses did not show any association between chronic statin or aspirin use and PEP. PDS and rectal indomethacin were protective in patients undergoing pancreatic duct injection. Pancreatic duct injection, fe-male sex, and younger age were associated with a higher risk. History of papillotomy was associated with lower risk only in the univariate analysis (all P values < 0.05).Conclusion: Chronic use of statins and aspirin appears to add no ad-ditional benefit to prevent ERCP pancreatitis. Rectal NSAIDs, and PDS after appropriate patient selection continue to be the main pro-phylactic measures. The lower incidence at our center compared with the reported data can be explained by the high rates of rectal indo-methacin and PDS, the use of noninvasive diagnostic modalities for patient selection, and the expertise of the endoscopists.