This is the current release of the guideline.

Pancreatic or hepatobiliary diseases including gallstones, cancers and pancreatitis

Diagnosis
Evaluation
Technology Assessment

Gastroenterology
Radiology

Physicians

• To promote the appropriate use of new or emerging endoscopic technologies and those technologies that impact practice
• To review the use of contrast media (CM) in endoscopic retrograde cholangiopancreatography (ERCP), including its relation to image quality, the likelihood for systemic absorption, and the risk for, and means of, reducing adverse reactions

Patients with known or suspected pancreatic or hepatobiliary diseases undergoing endoscopic retrograde cholangiopancreatography (ERCP)

1. Endoscopic retrograde cholangiopancreatography (ERCP)
2. In patients at high risk for contrast media (CM)-related reactions:
   • Steroid pretreatment
   • Substitution of low osmolality contrast media (LOCM) during ERCP

Note: Routine addition of antibiotics to CM was considered but not recommended.

Serious adverse events

Searches of Electronic Databases

Not stated

Not stated

Not stated

Not applicable

Review

Not stated

Not stated

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

Not stated

Not applicable

The safety data derived from studies of the intravascular use of low osmolality contrast media (LOCM) cannot be translated to endoscopic retrograde cholangiopancreatography (ERCP) in view of their low incidence of serious adverse events with nonvascular use. The evidence is lacking to support LOCM as a method for decreasing ERCP complications.

There is no justification for the routine use of LOCM during ERCP. In patients considered at high risk for contrast media (CM)-related reactions (i.e., those with a prior serious anaphylactoid reaction to intravascular CM), premedication and/or substitution of LOCM may be considered as an option based on the above-mentioned theoretical considerations.

The low frequency of sepsis after adequate biliary and pancreatic drainage at ERCP and the lack of data argue against the practice of routinely adding antibiotics to CM. Additional data are needed regarding the use of antibiotics in contrast media for those disease states in which optimal drainage cannot be accomplished.

None provided

The type of evidence supporting the recommendations is not specifically stated.

Prevention of serious adverse reactions to intravascular administration of contrast media for endoscopic retrograde cholangiopancreatography

• Systemic adverse reactions to contrast media (CM) used in endoscopic retrograde cholangiopancreatography (ERCP) have been documented, but their true incidence is unknown. Adverse reactions can be characterized as idiosyncratic or nonidiosyncratic, based on their proposed mechanisms. In general, nonidiosyncratic reactions are most likely dose and osmolality related, whereas idiosyncratic (anaphylactoid) reactions usually occur immediately. Acute CM reactions can be subdivided into minor, intermediate/moderate, and severe (see Table 1 "Categories of acute reactions" in the original guideline document).
• No statistical difference in the risk of clinical post-ERCP pancreatitis with the use of high osmolality contrast media (HOCM) vs. low osmolality contrast media (LOCM); however, high osmolar contrast was associated with an increased incidence of asymptomatic elevations of pancreatic enzymes.

To promote the appropriate use of new or emerging endoscopic technologies and those technologies that impact on endoscopic practice, the American Society for Gastrointestinal Endoscopy Technology Assessment Committee has developed a series of status evaluation papers. This process presents relevant information about these technologies to practicing physicians for the education and the care of their patients. In many cases, data from randomized controlled trials are lacking and only preliminary clinical studies are available. Practitioners should continue to monitor the medical literature for subsequent data about the efficacy, the safety, and the socioeconomic aspects of these technologies.

An implementation strategy was not provided.

Getting Better
Living with Illness
Staying Healthy

Safety

Not applicable: The guideline was not adapted from another source.

2005 Oct

American Society for Gastrointestinal Endoscopy - Medical Specialty Society

American Society for Gastrointestinal Endoscopy

Technology Assessment Committee

Committee Members: Daniel Mishkin, MD; Steven Carpenter, MD; Joseph Croffie, MD; Ram Chuttani, MD; James DiSario, MD; Nadeem Hussain, MD; Julia Liu, MD; Lehel Somogyi, MD; William Tierney, MD; Bret T. Petersen, MD (Chair)

Not stated

This is the current release of the guideline.

None available

None available

This NGC summary was completed by ECRI on May 1, 2007.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.