Frequency of post-ERCP pancreatitis in a single tertiary referral centre without and with routine prophylaxis with gabexate: A 6-year survey and cost-effectiveness analysis

P. A. Testoni, A. Mariani, E. Masci, S. Curioni

Research output: Contribution to journalArticle

Abstract

Background and study aims: Several drugs have been used for the prevention of post-ERCP pancreatitis with conflicting results and no data referring to the routine use of a pharmacological prophylaxis have been published up to now. Aim of the study was to evaluate the frequency of post-ERCP pancreatitis and costs in a series of consecutive patients who have undergone ERCP procedures before and after the introduction of a routine prophylaxis with gabexate in all cases. Patients and methods: Data from 1312 patients who underwent ERCP procedures without gabexate prophylaxis and from 1149 consecutive patients with 1 g i.v. gabexate, were retrospectively evaluated during a 6-year period. Patients were also subdivided in standard- and high-risk subjects, on the basis of patient- and technique-related risk factors: 984 subjects (39.9%) had one or more conditions that placed them at high risk for post-ERCP pancreatitis. Results: Post-ERCP pancreatitis was reported in 76 out of 2461 patients (3.1%). The frequency of pancreatitis appeared significantly reduced in the gabexate period in comparison with before gabexate in overall cases (2.2% versus 3.9%; p = 0.019); however, the reduction was significant only for high-risk patients (3.8% versus 7.3%; p = 0.001). Severe hyperamylasaemia at 4-6 h and 24 h after the procedure was also significantly reduced only in high-risk patients (p = 0.001). Routine prophylaxis with gabexate appeared cost-effective in high-risk patients. Conclusions: Routine gabexate prophylaxis was associated with a significant reduction of post-ERCP pancreatitis rate, severe hyperamylasaemia and hospitalisation-related costs only in high-risk patients. However, gabexate appeared unable to reduce the incidence of severe pancreatitis.

Original languageEnglish
Pages (from-to)588-595
Number of pages8
JournalDigestive and Liver Disease
Volume38
Issue number8
DOIs
Publication statusPublished - Aug 2006

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Gabexate
Endoscopic Retrograde Cholangiopancreatography
Tertiary Care Centers
Pancreatitis
Cost-Benefit Analysis
Costs and Cost Analysis
Surveys and Questionnaires

Keywords

  • ERCP
  • Gabexate prophylaxis
  • Post-procedural pancreatitis

ASJC Scopus subject areas

  • Gastroenterology

Cite this

@article{932ace5e754247a3a7dbcfd673cf43ec,
title = "Frequency of post-ERCP pancreatitis in a single tertiary referral centre without and with routine prophylaxis with gabexate: A 6-year survey and cost-effectiveness analysis",
abstract = "Background and study aims: Several drugs have been used for the prevention of post-ERCP pancreatitis with conflicting results and no data referring to the routine use of a pharmacological prophylaxis have been published up to now. Aim of the study was to evaluate the frequency of post-ERCP pancreatitis and costs in a series of consecutive patients who have undergone ERCP procedures before and after the introduction of a routine prophylaxis with gabexate in all cases. Patients and methods: Data from 1312 patients who underwent ERCP procedures without gabexate prophylaxis and from 1149 consecutive patients with 1 g i.v. gabexate, were retrospectively evaluated during a 6-year period. Patients were also subdivided in standard- and high-risk subjects, on the basis of patient- and technique-related risk factors: 984 subjects (39.9{\%}) had one or more conditions that placed them at high risk for post-ERCP pancreatitis. Results: Post-ERCP pancreatitis was reported in 76 out of 2461 patients (3.1{\%}). The frequency of pancreatitis appeared significantly reduced in the gabexate period in comparison with before gabexate in overall cases (2.2{\%} versus 3.9{\%}; p = 0.019); however, the reduction was significant only for high-risk patients (3.8{\%} versus 7.3{\%}; p = 0.001). Severe hyperamylasaemia at 4-6 h and 24 h after the procedure was also significantly reduced only in high-risk patients (p = 0.001). Routine prophylaxis with gabexate appeared cost-effective in high-risk patients. Conclusions: Routine gabexate prophylaxis was associated with a significant reduction of post-ERCP pancreatitis rate, severe hyperamylasaemia and hospitalisation-related costs only in high-risk patients. However, gabexate appeared unable to reduce the incidence of severe pancreatitis.",
keywords = "ERCP, Gabexate prophylaxis, Post-procedural pancreatitis",
author = "Testoni, {P. A.} and A. Mariani and E. Masci and S. Curioni",
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T1 - Frequency of post-ERCP pancreatitis in a single tertiary referral centre without and with routine prophylaxis with gabexate

T2 - A 6-year survey and cost-effectiveness analysis

AU - Testoni, P. A.

AU - Mariani, A.

AU - Masci, E.

AU - Curioni, S.

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N2 - Background and study aims: Several drugs have been used for the prevention of post-ERCP pancreatitis with conflicting results and no data referring to the routine use of a pharmacological prophylaxis have been published up to now. Aim of the study was to evaluate the frequency of post-ERCP pancreatitis and costs in a series of consecutive patients who have undergone ERCP procedures before and after the introduction of a routine prophylaxis with gabexate in all cases. Patients and methods: Data from 1312 patients who underwent ERCP procedures without gabexate prophylaxis and from 1149 consecutive patients with 1 g i.v. gabexate, were retrospectively evaluated during a 6-year period. Patients were also subdivided in standard- and high-risk subjects, on the basis of patient- and technique-related risk factors: 984 subjects (39.9%) had one or more conditions that placed them at high risk for post-ERCP pancreatitis. Results: Post-ERCP pancreatitis was reported in 76 out of 2461 patients (3.1%). The frequency of pancreatitis appeared significantly reduced in the gabexate period in comparison with before gabexate in overall cases (2.2% versus 3.9%; p = 0.019); however, the reduction was significant only for high-risk patients (3.8% versus 7.3%; p = 0.001). Severe hyperamylasaemia at 4-6 h and 24 h after the procedure was also significantly reduced only in high-risk patients (p = 0.001). Routine prophylaxis with gabexate appeared cost-effective in high-risk patients. Conclusions: Routine gabexate prophylaxis was associated with a significant reduction of post-ERCP pancreatitis rate, severe hyperamylasaemia and hospitalisation-related costs only in high-risk patients. However, gabexate appeared unable to reduce the incidence of severe pancreatitis.

AB - Background and study aims: Several drugs have been used for the prevention of post-ERCP pancreatitis with conflicting results and no data referring to the routine use of a pharmacological prophylaxis have been published up to now. Aim of the study was to evaluate the frequency of post-ERCP pancreatitis and costs in a series of consecutive patients who have undergone ERCP procedures before and after the introduction of a routine prophylaxis with gabexate in all cases. Patients and methods: Data from 1312 patients who underwent ERCP procedures without gabexate prophylaxis and from 1149 consecutive patients with 1 g i.v. gabexate, were retrospectively evaluated during a 6-year period. Patients were also subdivided in standard- and high-risk subjects, on the basis of patient- and technique-related risk factors: 984 subjects (39.9%) had one or more conditions that placed them at high risk for post-ERCP pancreatitis. Results: Post-ERCP pancreatitis was reported in 76 out of 2461 patients (3.1%). The frequency of pancreatitis appeared significantly reduced in the gabexate period in comparison with before gabexate in overall cases (2.2% versus 3.9%; p = 0.019); however, the reduction was significant only for high-risk patients (3.8% versus 7.3%; p = 0.001). Severe hyperamylasaemia at 4-6 h and 24 h after the procedure was also significantly reduced only in high-risk patients (p = 0.001). Routine prophylaxis with gabexate appeared cost-effective in high-risk patients. Conclusions: Routine gabexate prophylaxis was associated with a significant reduction of post-ERCP pancreatitis rate, severe hyperamylasaemia and hospitalisation-related costs only in high-risk patients. However, gabexate appeared unable to reduce the incidence of severe pancreatitis.

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