title: Incidence of post-ERCP pancreatitis from direct pancreatic juice collection in hereditary pancreatitis and familial pancreatic cancer before and after the introduction of prophylactic pancreatic stents and rectal diclofenac.
abstract: OBJECTIVE
  Individuals from hereditary pancreatitis (HP) and familial pancreatic cancer (FPC) kindreds are at increased risk of developing pancreatic cancer. Premalignant molecular changes may be detected in pancreatic juice collected by endoscopic retrograde cholangiopancreatography (ERCP). The objective was to determine the risk of post-ERCP pancreatitis (PEP).
  
  
  METHODS
  A prospective study (1999-2013) was undertaken of 80 ERCPs (24 in HP and 56 in FPC) from 60 individuals and the impact of PEP prophylaxis using a self-expelling pancreatic stent and 50 mg diclofenac per rectum from 2008.
  
  
  RESULTS
  There was no PEP in the HP cohort and 13 (23.2%) PEP from 56 procedures in the FPC cohort (P = 0.0077). Up to 2008 PEP had occurred in 7 (43.8%) of 16 procedures in FPC individuals versus none of 18 procedures in HP individuals (P = 0.0021). After the introduction of prophylaxis, the incidence of PEP fell to 6 (15.0%) of 40 procedures in FPC individuals (P = 0.0347).The odds ratio (95% confidence interval) was 0.23 (0.06-0.84) in favor of prophylaxis (0.035).
  
  
  CONCLUSIONS
  Individuals with HP are at minimal risk for PEP. Although the risk of PEP in individuals with FPC can be reduced by using prophylactic self-expelling stents and diclofenac, it remains too high for routine screening.
authors.affiliation: From the *National Institute for Health Research Liverpool Pancreas Biomedical Research Unit, Royal Liverpool University Hospital; †Liverpool Clinical Trials Unit; Departments of ‡Gastroenterology, and §Radiology, Royal Liverpool University Hospital, Liverpool; and ║Digestive Diseases Biomedical Research Unit, National Institute for Health Research Nottingham, Queen's Medical Centre, Nottingham, United Kingdom.
authors.forename: James A
authors.initials: JA
authors.lastname: Nicholson
authors.forename: William
authors.initials: W
authors.lastname: Greenhalf
authors.forename: Richard
authors.initials: R
authors.lastname: Jackson
authors.forename: Trevor F
authors.initials: TF
authors.lastname: Cox
authors.forename: Jane V
authors.initials: JV
authors.lastname: Butler
authors.forename: Thomas
authors.initials: T
authors.lastname: Hanna
authors.forename: Sara
authors.initials: S
authors.lastname: Harrison
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Grocock
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Halloran
authors.forename: Nathan R
authors.initials: NR
authors.lastname: Howes
authors.forename: Michael G
authors.initials: MG
authors.lastname: Raraty
authors.forename: Paula
authors.initials: P
authors.lastname: Ghaneh
authors.forename: Marianne
authors.initials: M
authors.lastname: Johnstone
authors.forename: Sanchoy
authors.initials: S
authors.lastname: Sarkar
authors.forename: Howard L
authors.initials: HL
authors.lastname: Smart
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Evans
authors.forename: Guruprasad P
authors.initials: GP
authors.lastname: Aithal
authors.forename: Robert
authors.initials: R
authors.lastname: Sutton
authors.forename: John P
authors.initials: JP
authors.lastname: Neoptolemos
authors.forename: Martin G
authors.initials: MG
authors.lastname: Lombard
mesh_terms: D000285:Administration, Rectal; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D014408:Biomarkers, Tumor / Q000235:genetics; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D004008:Diclofenac / Q000008:administration & dosage*; D005260:Female; D005820:Genetic Testing; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010189:Pancreatic Juice / Q000737:chemistry*; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000235:genetics; D010195:Pancreatitis / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D050500:Pancreatitis, Chronic / Q000175:diagnosis* / Q000235:genetics; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D014408:Biomarkers, Tumor; D004008:Diclofenac