# Poster Session I - A134 EVALUATING ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP) PANCREATITIS PREVENTION MEASURES AMONGST TWO TERTIARY CARE CENTERS IN WINNIPEG, MANITOBA: A QUALITY IMPROVEMENT STUDY

## TL;DR

This study compares pancreatitis prevention practices during ERCP procedures at two hospitals in Manitoba, finding similar outcomes but suggesting potential for standardized protocols.

## Contribution

The study evaluates the impact of different pre-ERCP protocols on pancreatitis prevention measures in two hospitals.

## Key findings

- ERCP pancreatitis prevention metrics were similar between the two centers.
- A higher proportion of patients received rectal indomethacin at SBH, though not statistically significant.
- SBH had a significantly higher rate of pancreatic duct stent use in patients with PD cannulation.

## Abstract

Two tertiary care centers provide ERCP services for the entire province of Manitoba. These centers differ in pre-ERCP indomethacin protocols. At Health Sciences Center (HSC) it is endoscopist driven and must be requested while at St. Boniface Hospital (SBH) it is part of a pre-ERCP nursing checklist. Assessing ERCP metrics ensures adherence to evidence-based best practices and minimizes procedural complications.

Conduct a quality improvement study comparing two tertiary care centers in Manitoba to evaluate for differences in pancreatitis prevention measures.

A retrospective chart review was conducted on all ERCPs performed by the three therapeutic endoscopists from January 1, 2025 to September 30, 2025. Data collected included patient age and sex, presence of a native papilla (NP), common bile duct (CBD) cannulation rate and difficulty (as defined by the 2016 ESGE ERCP guidelines), biliary stent placement rate, pancreatic duct (PD) cannulation rate and PD stent placement rate.

Between January 1, 2025 and September 30, 2025, 753 ERCPs were performed (n = 645 at SBH, n = 108 at HSC). The rectal indomethacin administration rate was higher at SBH (97.4% vs. 93.5%, p = 0.07). There was a significantly higher rate of PD stent use in patients with any PD cannulation at SBH (81.3% vs. 57.9%, p = 0.02). When assessing only those with ≥2 PD wire passes in patients with a NP, overall rates were >90%, favoring SBH (94.5% vs. 91.6%, p = 0.69). NP cannulation rates were similar at both sites (95.8% vs. 94.9%, p = 0.72). The most common indications for ERCP at SBH were CBD stones (45.3%) and stent removal (9.1%). At HSC they were CBD stones (38.0%) and bile duct obstruction (15.7%).

ERCP pancreatitis prevention quality metrics were similar between the two centers. A higher proportion of patients received rectal indomethacin at SBH, although this was not statistically significant. We have applied for ethics approval to investigate post-ERCP pancreatitis rates in this cohort. Based on these findings, we plan to propose the implementation of a standardized pre-ERCP checklist at HSC.

A127 Table 1: ERCP metrics at SBH and HSC

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