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Objective In 2010, the European Society of Gastrointestinal Endoscopy delivered guidelines on the prophylaxis of postendoscopic retrograde cholangiopancreatography (post-ERCP) pancreatitis (PEP). These included Grade A recommendations advising the use of prophylactic pancreatic stent (PPS) and non-steroidal anti-inflammatory drugs (NSAIDs) in high-risk cases. Our study aim was to capture the current practice of UK biliary endoscopists in the prevention of PEP. Design In summer 2012, an anonymous online 15-item survey was emailed to 373 UK consultant gastroenterologists, gastrointestinal surgeons and radiologists identified to perform ERCP. Results The response rate was 59.5%(222/373). Of the respondents, 52.5%considered ever using PPS for the prevention of PEP. PPS users always attempted insertion for the following procedural risk factors: pancreatic sphincterotomy (48.9%), suspected sphincter of Oddi dysfunction (46.5%), pancreatic duct instrumentation (35.9%), previous PEP (25.2%), precut sphincterotomy (8.5%) and pancreatic duct injection (7.8%). Prophylactic NSAID use was significantly associated with attempts at PPS placement (p<0.001). 64.1%of non-PPS users cited a lack of conviction in their benefit as the main reason for their decision. Self-reported pharmacological use rates for PEP prevention were: NSAIDs (34.6%), antibiotics (20.6%), rapid intravenous fluids (13.2%) and octreotide (1.6%). 6% routinely measured amylase post-ERCP. Conclusions Despite strong evidence-based guidelines for prevention of PEP, less than 53% of ERCP practitioners use pancreatic stenting or NSAIDs. This suggests a need for the development of British Society of Gastroenterology guidelines to increase awareness in the UK. Even among stent users, PPS are being underused for most high-risk cases. Prophylactic pharmacological measures were rarely used as was routine post-ERCP serum amylase measurement. [ABSTRACT FROM AUTHOR]

Objective Low bone mineral density (BMD) is common in chronic liver disease and predisposes to fracture. We aimed to compare British Society of Gastroenterology (BSG) and National Institute for Health and Clinical Excellence (NICE) osteoporosis guidelines with the fracture risk assessment tool (FRAX). FRAX is a web-based algorithm used to estimate fracture risk with or without dual-emission x-ray absorptiometry (DXA). Pre-BMD FRAX categorises patients to low, intermediate or high risk according to thresholds set by the National Osteoporosis Guidelines Group (NOGG) and recommends lifestyle advice, DXA or anti-osteoporosis treatment, respectively. Design The guidelines were applied to 132 patients with cirrhosis (91% Child-Pugh A). The number that would require DXA and be recommended treatment was determined. Using post-BMD FRAX/NOGG as a reference point, high- risk patients not recommended treatment and low- risk patients treated 'unnecessarily' were identified. Results BSG guidelines were applicable to 100% of the cohort, 88% required DXA and 30% would be recommended treatment. Equivalent figures for NICE guidelines were 30%, 17% and 12%, and for FRAX/NOGG guidelines were 78%, 27% and 15%, respectively. Using BSG guidance 8% of high-risk patients were not recommended treatment and 62% of those treated were low risk, compared with NICE: 3%, 60% and FRAX/NOGG: 13%, 40%, respectively. Conclusion For patients with Child--Pugh A cirrhosis BSG guidelines are the most inclusive, but have high cost implications in terms of DXA scanning and unnecessary treatment. Risk stratification using FRAX requires fewer DXA scans with minimal impact in terms of missing high-risk patients, and yields a modest reduction in unnecessary treatment. [ABSTRACT FROM AUTHOR]