ERCP IN ACUTE PANCREATITIS: A SURVEY OF CANADIAN ERCP PRACTITIONERS

NV Khanna, JC Gregor, TP Ponich

Division of Gastroenterology, London Health Sciences Centre, University of Western Ontario, London, Ontario

BACKGROUND: The use and timing of endoscopic retrograde cholangiopancreatography (ERCP) in acute idiopathic and gallstone pancreatitis remains controversial. We surveyed Canadian physicians and surgeons who perform ERCP to determine current practice patterns in this setting.
METHODS: We mailed surveys to 167 physicians and surgeons from our list of Canadian ERCP practitioners. The survey consisted of five clinical scenarios: a case of mild acute idiopathic pancreatitis, two cases of gallstone pancreatitis (mild and severe) without evidence of biliary obstruction and two cases of gallstone pancreatitis (mild and severe) with evidence of biliary obstruction. Each case had multiple choice questions about the use and timing of ERCP.
RESULTS: We had an overall response rate of 112 / 167 (67%). In mild acute idiopathic pancreatitis, only 18% of respondents would perform ERCP, whereas 82% would wait for two or more episodes, or evidence of biliary obstruction (p<0.0001). In mild gallstone pancreatitis with no biliary obstruction, 40% would perform ERCP, whereas 60% would only if there was evidence of biliary obstruction (p=0.04). In severe gallstone pancreatitis with no biliary obstruction, 70% would perform ERCP, whereas 30% would only if there was evidence of biliary obstruction (p<0.0001). In mild gallstone pancreatitis with evidence of biliary obstruction, 51% would perform ERCP within 72 hours. In severe gallstone pancreatitis with evidence of biliary obstruction, 72% would perform ERCP within 72 hours. ERCP was more likely to be performed within 72 hours of presentation in severe cases of pancreatitis both with and without evidence of biliary obstruction (p<0.001).
CONCLUSION: These results outline the current patterns of use of ERCP in acute idiopathic and gallstone pancreatitis among physicians and surgeons performing this procedure in Canada.