P1046 - Impact of High-Volume Crystalloid Infusion and Indomethacin Prophylaxis on Post-ERCP Pancreatitis Rates in Patients With Difficult Cannulation

Nitish Mittal, MD¹, Rachel Mortan, MD¹, Parvir Aujla, MD¹, Andrew Sullivan, MD², Dwight Fan, MD¹, Sruthi Kapliyil. Subramanian, MD, FACG¹, Abdullah S. Aleem, MD³, Veda Kulkarni, BS¹, Mairin Joseph-Talreja, MD, FACG¹, Srinivas Ramireddy, MD, FACG¹, Pritesh R. Mutha, MD, FACG¹, Vaibhav Wadhwa, MD, FACG¹, Nirav Thosani, MD⁴, Roy T. DaVee, MD, FACG^1
1University of Texas Health, McGovern Medical School, Houston, TX; ²University of Texas Health Science Center, Houston, TX; ³University of Texas at Houston, Houston, TX; ⁴McGovern Medical School at UTHealth, Houston, TX

Introduction: Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis (PEP) is the most common adverse event associated with Endoscopic Retrograde Cholangiopancreatography (ERCP), occurring in approximately 8% of all ERCPs and resulting in an annual estimated cost exceeding 150 million dollars in the United States. Post-Endoscopic Retrograde Cholangiopancreatography (ERCP) pancreatitis poses a substantial risk, particularly in cases involving difficult cannulation. This retrospective study investigates the potential benefits of administering greater than 2 liters of balanced crystalloids, combined with indomethacin, in reducing the incidence of post-ERCP pancreatitis and other complications in patients with difficult cannulation.

Methods: A retrospective cohort study was conducted, involving 588 patients who underwent ERCP at a multi-center institution from 2017 to 2023. Patients were categorized into two groups: those who received a high volume ( >2 liters) of balanced crystalloids and indomethacin with difficult cannulation (n=142), and those who did not had difficult cannulation (n=446). Electronic health records were reviewed for baseline characteristics, procedural details, and post-ERCP complications, with a specific focus on pancreatitis. Statistical analyses were employed using the Fisher exact test.

Results: Both groups have similar demographics and indications for ERCP. The group with >2L of balanced crystalloids and indomethacin with difficult cannulation had PEP of 6.34%, whereas patients without difficult cannulation had PEP of 1.79%. The findings revealed a statistically significant reduction in the incidence of post-ERCP pancreatitis in patients without difficult cannulation as compared to patients with difficult cannulation (p = 0.0088).

Discussion: This retrospective analysis revealed that patients without difficult cannulation had a statistically significant reduction in post-ERCP pancreatitis cases. Patients receiving rectal indomethacin and ≥ 2L of balanced crystalloids per American Society for Gastrointestinal Endoscopy (ASGE) guidelines for post-ERCP pancreatitis prevention strategies played a vital role to reduce the number of pancreatitis cases. This may be secondary to providers recognizing patients with higher-risk of developing PEP and more likely treating them peri procedurally with rectal indomethacin and balanced crystalloids. Further prospective, large randomized controlled trials are needed to assess the benefits.


Disclosures:


Nitish Mittal, MD¹, Rachel Mortan, MD¹, Parvir Aujla, MD¹, Andrew Sullivan, MD², Dwight Fan, MD¹, Sruthi Kapliyil. Subramanian, MD, FACG¹, Abdullah S. Aleem, MD³, Veda Kulkarni, BS¹, Mairin Joseph-Talreja, MD, FACG¹, Srinivas Ramireddy, MD, FACG¹, Pritesh R. Mutha, MD, FACG¹, Vaibhav Wadhwa, MD, FACG¹, Nirav Thosani, MD⁴, Roy T. DaVee, MD, FACG¹. P1046 - Impact of High-Volume Crystalloid Infusion and Indomethacin Prophylaxis on Post-ERCP Pancreatitis Rates in Patients With Difficult Cannulation, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.