From Guidelines to Real-World Practice: Adherence to Prophylactic Measures for Post-ERCP Pancreatitis and ERCP Quality Monitoring in Slovakia and Czechia

Abstract

Background and Aims: Endoscopic retrograde cholangiopancreatography (ERCP) is an established procedure for treatment of biliopancreatic disorders. However, it is associated with a risk of complications, most notably post-ERCP pancreatitis (PEP). Several evidence-based strategies have been shown to reduce this risk. These preventive measures, together with key ERCP quality indicators, are incorporated into international guidelines to enhance procedural safety and facilitate inter-center comparisons. This study aimed to evaluate the adherence of Slovak and Czech endoscopists to these recommendations.

Methods: A voluntary, 20-item cross-sectional survey was conducted among selected ERCP centers in Slovakia and Czechia using a cloud-based platform between January and June 2024.

Results: Twenty-six of 37 ERCP centers (70.3%, 14 from Slovakia and 12 from Czechia) responded to the survey. Post-ERCP pancreatitis and cannulation rates were systematically tracked by 53.8% and 38.5% of centers, respectively, and 42.4% applied objective measures when assessing difficult cannulation. Rectal nonsteroidal anti-inflammatory drugs (NSAIDs) were routinely administered to unselected ERCP patients in 53.9% of centers, while 75% of the remaining centers withheld them from patients with a history of ERCP and prior papillotomy. Indomethacin was the only NSAID used. Only 26.9% of centers employed aggressive hydration according to the recommended protocol. Twelve centers (46.2%) placed prophylactic pancreatic stents during difficult cannulation when the pancreatic duct was accessible, whereas six centers (23.1%) reported using pancreatic stents only rarely. No significant differences were observed between Slovak and Czech centers.

Conclusions: Current monitoring practices of key ERCP quality indicators in Slovakia and Czechia, such as PEP incidence and cannulation outcomes, fall short of recommended standards. Although most centers apply prophylactic measures, these are not used universally. This underscores the importance of implementing mandatory quality monitoring and promoting further standardization and improvement in preventive practice.