Gastroenterol Res

Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access

Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc

Journal website https://www.gastrores.org

Original Article

Volume 16, Number 3, June 2023, pages 149-156

Pharmacological and Endoscopic Interventions for Prophylaxis of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis

**Table 1.** Studies Evaluating the Utility of Statins and Aspirin as Prophylactic Method for PEP
Article	Design	Population sample	Main findings
ERCP: endoscopic retrograde cholangiopancreatography; PEP: post-ERCP pancreatitis.
Cardenas-Jaen et al, 2020 [23]	Multicenter prospective cohort	1,150 patients undergoing ERCP in 7 European centers	The use of statins or aspirin was not associated with a lower risk of PEP or lower severity
Martinez-Moreno et al, 2020 [26]	Multicenter retrospective cohort	702 patients that underwent ERCP in 4 Spanish tertiary-level hospitals	The use of statins was not associated with a lower risk of PEP or less severity
Hadi et al, 2020 [25]	Retrospective cohort study	1,162 ERCPs performed at West Virginia University during 2016 and 2017	Chronic statin use is protective against PEP
Hakuta et al, 2019 [27]	Retrospective cohort study	2,664 patients underwent ERCP between January 2010 and January 2019 in a tertiary center in Japan	Regular statin use was not protective against PEP
Facciorusso et al, 2019 [28]	Retrospective cohort study	1,543 patients that underwent ERCP in a tertiary center in Italy	Regular statin use was not protective against PEP
Mahamid et al, 2018 [24]	Retrospective cohort study	987 patients that underwent ERCP at the Shaare Zedek Medical Center in Jerusalem or EMMS Nazareth Hospital (Israel) from 2013 to 2015	Chronic use of statins (> 6 months) was found to be a protective factor against PEP
Facciorusso et al, 2020 [5]	Metanalysis	Nine studies, one prospective, eight retrospective trials with 9,374 patients	Non-superiority of chronic statin therapy in preventing PEP

Table 1. Studies Evaluating the Utility of Statins and Aspirin as Prophylactic Method for PEP

Article

Design

Population sample

Main findings

ERCP: endoscopic retrograde cholangiopancreatography; PEP: post-ERCP pancreatitis.

Cardenas-Jaen et al, 2020 [23]

Multicenter prospective cohort

1,150 patients undergoing ERCP in 7 European centers

The use of statins or aspirin was not associated with a lower risk of PEP or lower severity

Martinez-Moreno et al, 2020 [26]

Multicenter retrospective cohort

702 patients that underwent ERCP in 4 Spanish tertiary-level hospitals

The use of statins was not associated with a lower risk of PEP or less severity

Hadi et al, 2020 [25]

Retrospective cohort study

1,162 ERCPs performed at West Virginia University during 2016 and 2017

Chronic statin use is protective against PEP

Hakuta et al, 2019 [27]

Retrospective cohort study

2,664 patients underwent ERCP between January 2010 and January 2019 in a tertiary center in Japan

Regular statin use was not protective against PEP

Facciorusso et al, 2019 [28]

Retrospective cohort study

1,543 patients that underwent ERCP in a tertiary center in Italy

Regular statin use was not protective against PEP

Mahamid et al, 2018 [24]

Retrospective cohort study

987 patients that underwent ERCP at the Shaare Zedek Medical Center in Jerusalem or EMMS Nazareth Hospital (Israel) from 2013 to 2015

Chronic use of statins (> 6 months) was found to be a protective factor against PEP

Facciorusso et al, 2020 [5]

Metanalysis

Nine studies, one prospective, eight retrospective trials with 9,374 patients

Non-superiority of chronic statin therapy in preventing PEP

**Table 2.** Baseline Characteristics and Differences Between Treatment Groups
Variable	Total n = 681 (%)	Statin use	P	PD stent	P
PD: pancreatic duct; SD: standard deviation.
Age (SD)	54.6 (16.1)	51.8 (16.7)	64.1 (9.2)	< 0.001	54.7 (16.2)	54.0 (14.9)	0.75
Gender				0.34			0.06
Male	320 (47)	251	69		305	15
Female	361 (53)	271	90		330	31
Ethnicity				< 0.001			0.82
Black	240 (35.3)	162	78		222	18
Hispanic	231 (33.9)	198	33		215	16
White	130 (19.1)	101	29		124	6
Asian	45 (6.6)	30	15		41	4
Other	35 (5.1)	31	4		33	2
Setting				0.09			0.018
Outpatient	267 (39.2)	195	72		257	10
Inpatient	414 (60.8)	327	87		378	36
Indication				0.09			0.37
Biliary duct stone	237 (34.8)	189	48		220	17
Benign obstruction	210 (30.9)	154	56		197	13
Cholangitis	67 (9.8)	50	17		62	5
Malignant obstruction	90 (13.2)	63	27		87	3
Biliary leak	23 (3.4)	18	5		22	1
Other	54 (7.9)	48	6		47	7
Injection of PD	79 (11.6)	65	14	0.26	34	45	< 0.001
PD stenting	46 (7.8)	38	8	0.42	-	-	-
Papillotomy	331 (48.6)	264	67	0.08	290	41	< 0.001
History of papillotomy	306 (44.9)	226	80	0.14	301	5	< 0.001
Biliary stenting	401 (58.9)	307	94	0.99	383	18	0.008
Statin use	159 (23.5)	-	-	-	151	8	0.42
Aspirin use	111 (16.3)	34	77	< 0.001	100	11	0.21
Rectal indomethacin	439 (64.5)	333	106	0.57	398	41	< 0.001
Smoking	212 (31.1)	148	64	0.006	203	9	0.11

Table 2. Baseline Characteristics and Differences Between Treatment Groups

Variable

Total n = 681 (%)

Statin use

PD stent

No (n = 522)

Yes (n = 159)

No (n = 635)

Yes (n = 46)

PD: pancreatic duct; SD: standard deviation.

Age (SD)

54.6 (16.1)

51.8 (16.7)

64.1 (9.2)

< 0.001

54.7 (16.2)

54.0 (14.9)

0.75

Gender

0.34

0.06

Male

320 (47)

251

305

Female

361 (53)

271

330

Ethnicity

< 0.001

0.82

Black

240 (35.3)

162

222

Hispanic

231 (33.9)

198

215

White

130 (19.1)

101

124

Asian

45 (6.6)

Other

35 (5.1)

Setting

0.09

0.018

Outpatient

267 (39.2)

195

257

Inpatient

414 (60.8)

327

378

Indication

0.09

0.37

Biliary duct stone

237 (34.8)

189

220

Benign obstruction

210 (30.9)

154

197

Cholangitis

67 (9.8)

Malignant obstruction

90 (13.2)

Biliary leak

23 (3.4)

Other

54 (7.9)

Injection of PD

79 (11.6)

0.26

< 0.001

PD stenting

46 (7.8)

0.42

Papillotomy

331 (48.6)

264

0.08

290

< 0.001

History of papillotomy

306 (44.9)

226

0.14

301

< 0.001

Biliary stenting

401 (58.9)

307

0.99

383

0.008

Statin use

159 (23.5)

151

0.42

Aspirin use

111 (16.3)

< 0.001

100

0.21

Rectal indomethacin

439 (64.5)

333

106

0.57

398

< 0.001

Smoking

212 (31.1)

148

0.006

203

0.11

**Table 3.** Relationship Between Independent Variables and PEP
Variable	PEP (n = 12)	No PEP (n = 669)	Bivariate analysis (OR (95% CI))	P	Multivariate analysis (aOR (95% CI))	P
CI: confidence interval; OR: odds ratio; PEP: post-ERCP pancreatitis; SD: standard deviation.
Age (SD)	44.8 (16.4)	54.8 (16.1)	0.96 (0.92 - 0.99)	0.037	0.97 (0.93 - 1.01)	0.21
Gender
Male	2	318	0.22 (0.03 - 0.85)	0.048	0.18 (0.02 - 0.92)	0.047
Female	10	351
Race					-	-
Black	2	238	0.37 (0.034 - 8.05)	0.36
Hispanic	7	224	1.38 (0.24 - 26.03)	0.42
White	1	129	0.34 (0.01 - 8.75)	0.77
Asian	1	44	1.29 (0.05 - 33.5)	0.45
Other	1	34		0.86
Setting
Outpatient	1	266
Inpatient	11	403	7.3 (1.4 - 133)	0.058	3.87 (0.61 - 76.6)	0.22
Indication			-	0.38	-	-
Biliary duct stone	7	230
Benign obstruction	2	208
Cholangitis	1	66
Malignant obstruction	0	90
Biliary leak	1	22
Pancreatic mass	0	56
Other	1	53
Pancreatic duct injection	7	72	11.6 (3.61 - 40.12)	< 0.001	21.4 (5.28 - 93.6)	< 0.001
Pancreatic duct stenting	1	45	1.26 (0.07 - 6.7)	0.83	0.07 (0.003 - 0.56)	0.028
History of papillotomy	1	305	0.1 (0.006 - 0.56)	0.033	0.28 (0.01 - 1.98)	0.27
Biliary stenting	4	397	0.34 (0.09 - 1.09)	0.08	0.65 (0.15 - 2.5)	0.53
Statin use	1	158	0.29 (0.16 - 1.52)	0.24	0.64 (0.03 - 4.7)	0.7
Aspirin	1	110	0.46 (0.03 - 2.40)	0.46	-	-
Rectal indomethacin	8	431	1.09 (0.34 - 4.1)	0.86	0.39 (0.09 - 1.82)	0.20
Smoking	3	209	0.73 (0.16 - 2.49)	0.65	-	-

Table 3. Relationship Between Independent Variables and PEP

Variable

PEP (n = 12)

No PEP (n = 669)

Bivariate analysis (OR (95% CI))

Multivariate analysis (aOR (95% CI))

CI: confidence interval; OR: odds ratio; PEP: post-ERCP pancreatitis; SD: standard deviation.

Age (SD)

44.8 (16.4)

54.8 (16.1)

0.96 (0.92 - 0.99)

0.037

0.97 (0.93 - 1.01)

0.21

Gender

Male

318

0.22 (0.03 - 0.85)

0.048

0.18 (0.02 - 0.92)

0.047

Female

351

Race

Black

238

0.37 (0.034 - 8.05)

0.36

Hispanic

224

1.38 (0.24 - 26.03)

0.42

White

129

0.34 (0.01 - 8.75)

0.77

Asian

1.29 (0.05 - 33.5)

0.45

Other

0.86

Setting

Outpatient

266

Inpatient

403

7.3 (1.4 - 133)

0.058

3.87 (0.61 - 76.6)

0.22

Indication

0.38

Biliary duct stone

230

Benign obstruction

208

Cholangitis

Malignant obstruction

Biliary leak

Pancreatic mass

Other

Pancreatic duct injection

11.6 (3.61 - 40.12)

< 0.001

21.4 (5.28 - 93.6)

< 0.001

Pancreatic duct stenting

1.26 (0.07 - 6.7)

0.83

0.07 (0.003 - 0.56)

0.028

History of papillotomy

305

0.1 (0.006 - 0.56)

0.033

0.28 (0.01 - 1.98)

0.27

Biliary stenting

397

0.34 (0.09 - 1.09)

0.08

0.65 (0.15 - 2.5)

0.53

Statin use

158

0.29 (0.16 - 1.52)

0.24

0.64 (0.03 - 4.7)

0.7

Aspirin

110

0.46 (0.03 - 2.40)

0.46

Rectal indomethacin

431

1.09 (0.34 - 4.1)

0.86

0.39 (0.09 - 1.82)

0.20

Smoking

209

0.73 (0.16 - 2.49)

0.65