Dietary approaches following endoscopic retrograde cholangiopancreatography: A survey of selected endoscopists

Table 1 Physicians demographics and endoscopic retrograde cholangiopancreatography experience

Age group (y)	≤39	40-49	50-59	≥60	Missed
n (%)	12 (12.4)	43 (44.3)	31 (31.9)	11 (11.4)	0 (0)
ERCP/year	0	< 50	51-250	> 250	Missed
n (%)	3 (3.1)	8 (8.3)	37 (38.1)	49 (50.5)	0 (0)
Location	Northeast	Southeast	Southwest	Northwest	Missed
n (%)	47 (48.5)	13 (13.4)	13 (13.4)	21 (21.6)	3 (3.1)
NYP ERCP	< 5 yr	5-10 yr	11-15 yr	> 15 yr	Missed
n (%)	10 (10.3)	12 (12.4)	14 (14.4)	60 (61.8)	1 (1.1)

NYP ERCP: Number of years performing endoscopic retrograde cholangiopancreatography.

Table 2 Type of diet prescribed after endoscopic retrograde cholangiopancreatography

Type of diet	Risk of pancreatitis
	NPO	CL	Low-fat	Normal	Total
	n (%)	n (%)	n (%)	n (%)	n (%)
Low	0 (0)	51 (52.6)	17 (17.5)	29 (29.9)	97 (100)
Medium	4 (4.1)	81 (83.5)	5 (5.2)	7 (7.2)	97 (100)
High	24 (24.7)	69 (71.1)	2 (2.1)	2 (2.1)	97 (100)

CL: clear liquids; NPO: nil per os.

Table 3 Timing to resumption of oral intake after endoscopic retrograde cholangiopancreatography

Resume oral intake	Risk of pancreatitis
	Immediately	4 h later	6 h later	12 h later	24 h later	Total
	n (%)	n (%)	n (%)	n (%)	n (%)	n (%)
Low	71 (73.2)	21 (21.6)	2 (2.1)	1 (1.0)	2 (2.1)	97 (100)
Medium	56 (57.7)	29 (29.9)	4 (4.1)	3 (3.1)	5 (5.2)	97 (100)
High	49 (50.5)	18 (18.5)	7 (7.2)	6 (6.2)	17 (17.6)	97 (100)

Table 4 Paired diet recommendations by patient scenario

				Significance1	% who changed recommendation based on scenario
		Moderate risk
		NPO/CL	L-F/Normal
High risk	NPO/CL	83	10	0.04	12/97 (12%)
	L-F/Normal	2	2
		Low risk
High risk	NPO/Clears	51	42	< 0.001	42/97 (43%)
	L-F/Normal	0	4
		Low risk
Mod risk	NPO/CL	50	35	< 0.001	36/97 (37%)
	L-F/Normal	1	11

¹McNemar test; CL: clear liquids; L-F: low-fat; NPO: nil per os.

Table 5 Paired time to first oral intake recommendations by patient scenario

				Significance1	% who changed recommendation based on scenario
		Moderate risk
		Not delayed	Delayed
High risk	Not delayed	73	1	< 0.001	17/97 (18%)
	Delayed	16	7
		Low risk
High risk	Not delayed	74	0	< 0.001	20/97 (21%)
	Delayed	20	3
		Low risk
Mod risk	Not delayed	88	1	0.125	7/97 (7%)
	Delayed	6	2

¹McNemar test.

Table 6 Diet type recommended based on age, practice location, number of endoscopic retrograde cholangiopancreatographys performed per year and years of endoscopic retrograde cholangiopancreatography experience of respondents

Physician characteristic			Risk of post-ERCP pancreatitis
			High vs medium		High vs low		Medium vs low
		Total number of pairs	Number with different recommendationsb		Number with different recommendationsb		Number with different recommendationsb
			n (%)	P-valuea	n (%)	P-valuea	n (%)	P-valuea
ERCP experience1	≤ 15 yr	36	4 (11)		17 (47)		17 (47)
	> 15 yr	60	8 (13)	1.00	24 (40)	0.49	18 (30)	0.09
Number of ERCPs/year	≤ 250	48	6 (12)		21 (44)		15 (31)
	> 250	49	6 (12)	0.97	21 (43)	0.93	21 (43)	0.24
Age of physician	< 45	30	4 (13)		15 (50)		15 (50)
	45-54	49	5 (10)		19 (39)		16 (33)
	≥ 55	18	3 (17)	0.78	8 (44)	0.62	5 (28)	0.20
Residency of physician2	NE	47	5 (11)		23 (49)		22 (47)
	SE	13	2 (15)		5 (38)		3 (23)
	SW	13	3 (23)		8 (62)		5 (38)
	NW	21	2 (10)	0.63	6 (29)	0.24	6 (29)	0.36

^aSignificance of the association between physician variable and recommendation of different diets assessed using a Chi-square or Fisher’s exact test as appropriate;

^bRecommended diet dichotomized as: NPO/Clears vs Low-Fat/Normal, to define “Different Recommendation”;

¹Not completed for 1 physician;

²Not completed for 3 physicians; ERCP: endoscopic retrograde cholangiopancreatography.

Table 7 Timing of resumption of diet recommended based on age, practice location, number of endoscopic retrograde cholangiopancreatographys performed per year and years of endoscopic retrograde cholangiopancreatography experience of respondents

Physician characteristic			Risk of post-ERCP pancreatitis
			High vs medium		High vs low		Medium vs low
		Total number of pairs	Different timing recommendation		Different timing recommendation		Different timing recommendation
			n (%)	P-valuea	n (%)	P-valuea	n (%)	P-valuea
ERCP experience1	≤ 15 yr	36	8 (22)		9 (25)		1 (3)
	> 15 yr	60	9 (15)	0.37	11 (18)	0.44	6 (10)	0.09
Number of ERCPs/year	≤ 250	48	7 (15)		8 (17)		1 (2)
	> 250	49	10 (20)	0.45	12 (24)	0.34	6 (12)	0.11
Age of physician	< 45	30	6 (20)		6 (20)		0 (0)
	45-54	49	8 (16)		12 (24)		6 (12)
	≥ 55	18	3 (17)	0.91	2 (11)	0.48	1 (6)	0.12
Residency of physician2	NE	47	11 (23)		14 (30)		5 (11)
	SE	13	2 (15)		3 (23)		1 (8)
	SW	13	2 (15)		2 (15)		0 (0)
	NW	21	2 (21)	0.59	1 (5)	0.11	1 (5)	0.79

^aSignificance of the association between physician variable and recommendation of different timing for the recommended diets assessed using a Chi-square or Fisher’s exact test as appropriate. Timing dichotomized as: Immediate/4h/6h vs 12h/24h, to define “Different Timing Recommended”;

¹Not completed for 1 physician;

²Not completed for 3 physicians; ERCP: endoscopic retrograde cholangiopancreatography.

Table 8 Diet type recommended based on clinical factors considered important or not by the respondents

Clinical factors			Risk of post-ERCP pancreatitis
			High vs medium		High vs low		Medium vs low
		Total number of pairs	Number with different recommendationsb		Number with different recommendationsb		Number with different recommendationsb
			n (%)	P-valuea	n (%)	P-valuea	n (%)	P-valuea
Risk of post-ERCP pancreatitis1	Important	12	2 (17)		4 (33)		2 (17)
	Unimportant	84	10 (12)	0.64	38 (45)	0.44	34 (40)	0.20
Risk other post-ERCP complication1	Important	29	3 (10)		12 (41)		9 (31)
	Unimportant	67	9 (13)	1.00	30 (45)	0.76	27 (40)	0.39
Post-ERCP symptoms1	Important	11	1 (9)		2 (18)		3 (27)
	Unimportant	85	11 (13)	1.00	40 (47)	0.11	33 (39)	0.53
Patient co-morbid medical illnesses2	Important	60	9 (15)		27 (45)		24 (40)
	Unimportant	35	3 (9)	0.53	15 (43)	0.84	12 (34)	0.58
Inpatient/outpatient status3	Important	60	6 (10)		26 (43)		24 (40)
	Unimportant	34	5 (15)	0.52	15 (44)	0.94	12 (35)	0.65

^aSignificance of the association between physician importance answers and recommendation of different diets assessed using a Chi-square or Fisher’s exact test as appropriate.

^bRecommended diet dichotomized as NPO/Clears vs Low-Fat/Normal to define “Different Recommendation” importance dichotomized as: Very/Somewhat Important →“Important vs Neither/Somewhat/Very Unimportant →“Unimportant”;

¹Not completed for 1 physician;

²Not completed for physicians;

³Not completed for 3 physicians; ERCP: endoscopic retrograde cholangiopancreatography.

Table 9 Timing of resume diet recommended based on clinical factors considered important or not by the respondents

Clinical factors			Risk of post-ERCP pancreatitis
			High vs medium		High vs low		Medium vs low
		Total number of pairs	Number with different recommendationsb		Number with different recommendationsb		Number with different recommendationsb
			n (%)	P-valuea	n (%)	P-valuea	n (%)	P-valuea
Risk of post-ERCP pancreatitis2	Important	14	1 (7)		1 (7)		0 (0)
	Unimportant	81	16 (20)	0.45	19(23)	0.29	7 (9)	0.59
Risk other post-ERCP complication1	Important	26	4 (15)		4 (15)		2 (8)
	Unimportant	70	13 (19)	1.00	16 (23)	0.42	5 (7)	1.00
Post-ERCP symptoms1	Important	12	1 (8)		0 (0)		1 (8)
	Unimportant	84	16 (19)	0.69	20 (24)	0.07	6 (7)	1.00
Patient co-morbid medical illnesses1	Important	65	11 (17)		12 (18)		5 (8)
	Unimportant	31	6 (19)	0.77	8 (26)	0.41	2 (6)	1.00
Inpatient/outpatient status2	Important	65	8 (12)		11 (17)		5 (8)
	Unimportant	30	9 (30)	0.04	9 (30)	0.15	2 (7)	1.00

^aSignificance of the association between physician importance answers and recommendation of different diets assessed using a Chi-square or Fisher’s exact test as appropriate.

^bRecommended diet dichotomized as NPO/Clears vs Low-Fat/Normal to define “Different Recommendation” importance dichotomized as: Very/Somewhat Important →“Important vs Neither/Somewhat/Very Unimportant →“Unimportant”;

¹Not completed for 1 physician;

²Not completed for physicians; ERCP: endoscopic retrograde cholangiopancreatography.