Su1688 Proton Pump Inhibitor (PPI) Does Not Prevent Post-ERCP Pancreatitis

Su1688 Proton Pump Inhibitor (PPI) Does Not Prevent Post-ERCP Pancreatitis Mohamed M. Abdelfatah*, Rabih Nayfe, ALA Nijim, Markus Agito, Nairmeen Haller AGMC, Northeast Ohio university, Akron, OH Background: Post-ERCP pancreatitis (PEP) is a feared complication of ERCP, and occurs in up to 20% of high-risk patients. Proton pump inhibitors (omeprazole, esomeprazole) are widely used for different indications; their therapeutic role in pancreatitis is unclear. Methods: A single-center retrospective case-control study was conducted to evaluate the potential effect of PPIs in preventing PEP. All patients who underwent ERCP between January 2007 and February 2012 were included. After obtaining IRB approval, all medical records were reviewed and data was collected for laboratory blood work done before and after the procedure, home and newly prescribed medications, in addition to the detailed operative notes. PEP was defined based on new onset abdominal pain requiring hospitalization for at least 2 nights and elevation of lipase and/or amylase R3 times the upper limit of normal at least 24 hours after the procedure. Univariable and multivariable analyses were performed to compare rates of PEP in the group of patients who received IV antibiotics, PPI, or both; analysis adjusted for potential or suspected confounding factors. Results: Among the 197 ERCPs done during the study period, the average age was found to be 62.3 (86-27), 107 patients were females and average BMI was 26.9 (44.6-16.4). Laboratory blood work showed an average WBC of 7.8 (19.6-3), hematocrit of 35.7 (54-22.9), BUN of16 (36-3), creatinine of 1 (4.4-.39), AST of 97 (944-10), calcium of 8.6 (10.3-8.6) and an LDH 250 (505-153). A total of twelve patients developed PEP, out of which, nine had severe PEP, two had moderate PEP and one had mild PEP. Lipase level was (10359-4691). In-group (1) [patients who used PPI], out of ninetyeight patients, seven had PEP (6 severe PEP, 1 mild PEP) as compared to group (2) [patients who did not use PPI], where 5 patients had PEP (3 severe, 2 moderate). There was no statistically significant difference in the incidence and severity of PEP between group (1) and group (2) (p-valueZ0.538). Table 1 presents a list of variables considered in our study, that even after adjusting for these variables and exploring other models, no associations were found between PPI and PEP. [Table 1] History of PEP, female gender, difficult cannulation/failed attempt was significantly associated with an increased incidence of PEP. However, pancreatic stent placement, diabetes mellitus, obesity, and history of acute pancreatitis were not associated with increased incidence of PEP [Table 1]. High Pre-ERCP blood sugar failed to show association with PEP (p-valueZ0.0841) (Fig.1). Conclusion: Our study did not show significant evidence to support the role played by (PPI) in decreasing the incidence or severity of post-ERCP pancreatitis. Further randomized controlled studies are needed. Factors might increase or decease the incidence of PEP.