{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T13:57:36Z","timestamp":1787234256847,"version":"build-2736575974"},"reference-count":35,"publisher":"Georg Thieme Verlag KG","issue":"07","license":[{"start":{"date-parts":[[2021,6,17]],"date-time":"2021-06-17T00:00:00Z","timestamp":1623888000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Endosc Int Open"],"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background and study aims\u2002Incidence of Post-ERCP pancreatitis (PEP) ranges from 1\u200a% to 10\u200a% in unselected patients and as high as 25\u200a% to 30\u200a% in high-risk patients. Rectal indomethacin administered before or immediately after an ERCP and prophylactic pancreatic duct stent placement (PPS) are associated with a reduction in the incidence of PEP. We sought to investigate the utilization rate for prophylactic rectal indomethacin and PPS in average and high-risk patients undergoing ERCP between 2014 and 2019.<\/jats:p><jats:p>\n          Patients and methods\u2002We performed a retrospective analysis in the IBM Explorys database, a pooled, national de-identified clinical database of over 72 million unique patients from 26 health care networks and 300 hospitals across the United States from 2014 to 2019. Average and high-risk patients undergoing ERCP were identified using Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) diagnosis codes. PEP was defined by the presence of SNOMED CT diagnosis of acute pancreatitis and an inpatient admission within 5 days of an ERCP procedure. <\/jats:p><jats:p>\n          Results\u2002Out of 31,050 adults who had undergone ERCP from 2014 to 2019, only 10,500 individuals (33.8\u200a%) had a PEP prophylaxis. Rectal indomethacin and PPS accounted for 82.4\u200a% and 12.9\u200a% respectively. Individuals with three risk factors had the highest PEP rates followed by individuals with two risk factors. <\/jats:p><jats:p>\n          Conclusions\u2002Only one-third of all patients undergoing ERCP received prophylaxis in the form of rectal indothemacin and\/or PPS in this large population-based data. Increased implementation of prophylactic use is needed in patients undergoing ERCP as supported by current guidelines. <\/jats:p>","DOI":"10.1055\/a-1460-7776","type":"journal-article","created":{"date-parts":[[2021,6,17]],"date-time":"2021-06-17T22:30:17Z","timestamp":1623969017000},"page":"E979-E985","source":"Crossref","is-referenced-by-count":11,"title":["Underutilization of prophylactic rectal indomethacin and pancreatic duct stent for prevention of post-ERCP Pancreatitis"],"prefix":"10.1055","volume":"09","author":[{"given":"Abdulfatah","family":"Issak","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Metrohealth Medical Center, Case Western Reserve University, Cleveland, Ohio, United States"},{"name":"Department of Internal Medicine, Metrohealth Medical Center, Case Western Reserve University, Cleveland, Ohio, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abbinaya","family":"Elangovan","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Metrohealth Medical Center, Case Western Reserve University, Cleveland, Ohio, United States"},{"name":"Department of Internal Medicine, Metrohealth Medical Center, Case Western Reserve University, Cleveland, Ohio, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roy D.","family":"Ferguson","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Metrohealth Medical Center, Case Western Reserve University, Cleveland, Ohio, United States"},{"name":"Department of Internal Medicine, Metrohealth Medical Center, Case Western Reserve University, Cleveland, Ohio, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nisheet","family":"Waghray","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Metrohealth Medical Center, Case Western Reserve University, Cleveland, Ohio, United States"},{"name":"Department of Internal Medicine, Metrohealth Medical Center, Case Western Reserve University, Cleveland, Ohio, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dalbir S.","family":"Sandhu","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2021,6,17]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/j.gie.2011.03.1233","article-title":"Are low-volume ERCPists a problem in the United States? A plea to examine and improve ERCP practice-NOW","volume":"74","author":"P B Cotton","year":"2011","journal-title":"Gastrointest Endosc"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1053\/j.gastro.2018.08.063","article-title":"Burden and cost of gastrointestinal, liver, and pancreatic diseases in the united states: update 2018","volume":"156","author":"A F Peery","year":"2019","journal-title":"Gastroenterology"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"1781","DOI":"10.1111\/j.1572-0241.2007.01279.x","article-title":"Incidence rates of post-ERCP complications: a systematic survey of prospective studies","volume":"102","author":"A Andriulli","year":"2007","journal-title":"Am J Gastroenterol"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1093\/jcag\/gwy006","article-title":"Rectal indomethacin prevents moderate to severe post-ERCP pancreatitis and death and should be used before the procedure: a meta-analysis of aggregate subgroup data","volume":"1","author":"M Yaghoobi","year":"2018","journal-title":"J Can Assoc Gastroenterol"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1016\/j.gie.2019.11.013","article-title":"Practice patterns of post-ERCP pancreatitis prophylaxis techniques in the United States: a survey of advanced endoscopists","volume":"91","author":"P Avila","year":"2020","journal-title":"Gastrointest Endosc"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"1753","DOI":"10.1038\/ajg.2010.136","article-title":"Risk factors for post-ERCP pancreatitis in high- and low-volume centers and among expert and non-expert operators: a prospective multicenter study","volume":"105","author":"P A Testoni","year":"2010","journal-title":"Am J Gastroenterol"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1055\/s-0034-1377875","article-title":"Prophylaxis of post-ERCP pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Guideline \u2013 updated June 2014","volume":"46","author":"J M Dumonceau","year":"2014","journal-title":"Endoscopy"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.gie.2016.06.051","article-title":"Adverse events associated with ERCP","volume":"85","author":"ASGE Standards of Practice Committee","year":"2017","journal-title":"Gastrointest Endosc"},{"key":"ref9","first-page":"22","article-title":"Preventing post-ERCP pancreatitis: where are we?","volume":"4","author":"P A Testoni","year":"2003","journal-title":"JOP"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/j.gie.2014.06.045","article-title":"Incidence, severity, and mortality of post-ERCP pancreatitis: a systematic review by using randomized, controlled trials","volume":"81","author":"B Kochar","year":"2015","journal-title":"Gastrointest Endosc"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1067\/mge.2003.124","article-title":"Does a pancreatic duct stent prevent post-ERCP pancreatitis? A prospective randomized study.","volume":"57","author":"A Fazel","year":"2003","journal-title":"Gastrointest Endosc"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1016\/S0016-5107(04)02013-9","article-title":"Does prophylactic pancreatic stent placement reduce the risk of post-ERCP acute pancreatitis? A meta-analysis of controlled trials","volume":"60","author":"P Singh","year":"2004","journal-title":"Gastrointest Endosc"},{"key":"ref13","first-page":"58","article-title":"Mechanical prevention of post-ERCP pancreatitis by pancreatic stents: results, techniques, and indications","volume":"4","author":"P R Tarnasky","year":"2003","journal-title":"JOP"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"E860","DOI":"10.1055\/a-0886-6384","article-title":"Pancreatic stenting to prevent post-ERCP pancreatitis: a randomized multicenter trial","volume":"7","author":"V Phillip","year":"2019","journal-title":"Endosc Int Open"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"1262","DOI":"10.1136\/gut.2007.140756","article-title":"A meta-analysis of rectal NSAIDs in the prevention of post-ERCP pancreatitis","volume":"57","author":"B J Elmunzer","year":"2008","journal-title":"Gut"},{"key":"ref16","first-page":"9784841","article-title":"Rectal indomethacin is protective against pancreatitis after endoscopic retrograde cholangiopancreatography: systematic review and meta-analysis","volume":"2018","author":"X He","year":"2018","journal-title":"Gastroenterol Res Pract"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"1414","DOI":"10.1056\/NEJMoa1111103","article-title":"A randomized trial of rectal indomethacin to prevent post-ERCP pancreatitis","volume":"366","author":"B J Elmunzer","year":"2012","journal-title":"N Engl J Med"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1002\/jhbp.259","article-title":"Japanese guidelines for the management of acute pancreatitis: Japanese Guidelines 2015","volume":"22","author":"M Yokoe","year":"2015","journal-title":"J Hepatobiliary Pancreat Sci"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1136\/flgastro-2013-100323","article-title":"UK wide survey on the prevention of post-ERCP pancreatitis","volume":"5","author":"M S Hanna","year":"2014","journal-title":"Frontline Gastroenterol"},{"key":"ref21","first-page":"965","article-title":"Patient characteristics associated with venous thromboembolic events: a cohort study using pooled electronic health record data","volume":"19","author":"D C Kaelber","year":"2012","journal-title":"JAMIA"},{"key":"ref22","first-page":"602","article-title":"Migrating existing clinical content from ICD-9 to SNOMED","volume":"17","author":"P M Nadkarni","year":"2010","journal-title":"JAMIA"},{"key":"ref23","doi-asserted-by":"crossref","first-page":"934","DOI":"10.14309\/ajg.0000000000000623","article-title":"Real-world practice patterns in the era of rectal indomethacin for prophylaxis against post-ERCP pancreatitis in a high-risk cohort","volume":"115","author":"Z L Smith","year":"2020","journal-title":"Am J Gastroenterol"},{"key":"ref24","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1016\/j.gie.2016.10.023","article-title":"Rectal Indomethacin should be used routinely in all patients for the prevention of post-ERCP pancreatitis","volume":"895","author":"J A Barkin","year":"2017","journal-title":"Gastrointest Endosc"},{"key":"ref25","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/j.gie.2016.08.034","article-title":"Rectal indomethacin is protective against post-ERCP pancreatitis in high-risk patients but not average-risk patients: a systematic review and meta-analysis","volume":"85","author":"S Inamdar","year":"2017","journal-title":"Gastrointest Endosc"},{"key":"ref26","doi-asserted-by":"crossref","first-page":"505","DOI":"10.17235\/reed.2018.5259\/2017","article-title":"Rectal diclofenac does not prevent post-ERCP pancreatitis in consecutive high-risk and low-risk patients","volume":"110","author":"L Del Olmo Mart\u00ednez","year":"2018","journal-title":"Rev Esp Enferm Dig"},{"key":"ref27","doi-asserted-by":"crossref","first-page":"1247","DOI":"10.1111\/jgh.14948","article-title":"Low-dose rectal diclofenac does not prevent post-ERCP pancreatitis in low- or high-risk patients","volume":"35","author":"T Katoh","year":"2020","journal-title":"J Gastroenterol Hepatol"},{"key":"ref28","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1016\/j.gie.2006.10.030","article-title":"Prophylactic administration of somatostatin or gabexate does not prevent pancreatitis after ERCP: an updated meta-analysis","volume":"65","author":"A Andriulli","year":"2007","journal-title":"Gastrointest Endosc"},{"key":"ref29","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1097\/MCG.0b013e3181eb600e","article-title":"A randomized controlled trial of valdecoxib and glyceryl trinitrate for the prevention of post-ERCP pancreatitis","volume":"45","author":"V Bhatia","year":"2011","journal-title":"J Clin Gastroenterol"},{"key":"ref30","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s10620-008-0709-9","article-title":"Nitroglycerin in the prevention of post-ERCP pancreatitis: a meta-analysis","volume":"55","author":"L M Shao","year":"2010","journal-title":"Dig Dis Sci"},{"key":"ref31","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1067\/mge.2003.307","article-title":"Does prophylactic administration of corticosteroid reduce the risk and severity of post-ERCP pancreatitis: a randomized, prospective, multicenter study","volume":"58","author":"S Sherman","year":"2003","journal-title":"Gastrointest Endosc"},{"key":"ref32","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1016\/j.cgh.2012.12.043","article-title":"Rectal nonsteroidal anti-inflammatory drugs are superior to pancreatic duct stents in preventing pancreatitis after endoscopic retrograde cholangiopancreatography: a network meta-analysis","volume":"11","author":"A Akbar","year":"2013","journal-title":"Clin Gastroenterol Hepatol"},{"key":"ref33","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1067\/mge.2001.117550","article-title":"Risk factors for post-ERCP pancreatitis: a prospective, multicenter study","volume":"54","author":"M L Freeman","year":"2001","journal-title":"Gastrointest Endosc"},{"key":"ref34","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1097\/00006676-199105000-00013","article-title":"ERCP- and endoscopic sphincterotomy-induced pancreatitis","volume":"6","author":"S Sherman","year":"1991","journal-title":"Pancreas"},{"key":"ref35","doi-asserted-by":"crossref","first-page":"1518","DOI":"10.1016\/S0016-5085(98)70031-9","article-title":"Pancreatic stenting prevents pancreatitis after biliary sphincterotomy in patients with sphincter of Oddi dysfunction","volume":"115","author":"P R Tarnasky","year":"1998","journal-title":"Gastroenterology"},{"key":"ref36","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/S0016-5107(98)70121-X","article-title":"Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study","volume":"48","author":"S Loperfido","year":"1998","journal-title":"Gastrointest Endosc"}],"container-title":["Endoscopy International Open"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-1460-7776.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,6,17]],"date-time":"2021-06-17T22:30:37Z","timestamp":1623969037000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-1460-7776"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,17]]},"references-count":35,"journal-issue":{"issue":"07","published-online":{"date-parts":[[2021,6,17]]},"published-print":{"date-parts":[[2021,7]]}},"URL":"https:\/\/doi.org\/10.1055\/a-1460-7776","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["2364-3722","2196-9736"],"issn-type":[{"value":"2364-3722","type":"print"},{"value":"2196-9736","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6,17]]}}}