IMPROVING HELICOBACTER PYLORI TESTING IN PATIENTS WITH ACUTE UPPER GI BLEEDING DUE TO PEPTIC ULCER DISEASE (POSTER PRESENTATION)

Aim: Single operator cholangiopancreatoscopy (SOC) is increasingly performed during ERCP across various practice settings.Though safe overall, post-procedure bacteremia and cholangitis is a well-documented adverse event with rates reported significantly higher than ERCP alone.Therefore, expert opinion consensus recommends routine use of prophylactic antibiotics.Our aim is to investigate the practice pattern of prophylactic antibiotic use for SOC across a large multi-hospital system, including community practice and tertiary care academic center.Methods: Retrospective chart review conducted of procedures performed between Oct 2013-May 2018 across a large ( 14) multi-hospital health system, including an academic tertiary referral center and multiple community hospitals.Antibiotic usage was determined by documentation on procedure reports.Secondary analysis performed based on endoscopist practice location: academic practice at tertiary referral center vs community practice.A subcategory based on the indication of the procedure was also evaluated (choledocholithiasis with or without stone fragmentation, stricture or mass evaluation, pancreatoscopy, and other).Results: We identified 7,400 ERCP procedures performed by 66 different endoscopists.439 procedures were performed with SOC.Of these, 204 procedures (46.5%) were performed in a tertiary care academic center and 235 procedures (53.5%) were performed in a community setting.Across the entire hospital system, only 166 of 439 (37.8%) patients undergoing ERCP with SOC were reported to have received antibiotics (Table 1).However, in the subanalysis, academic/tertiary centers reported significantly more antibiotic use with SOC compared to community medical centers: 69.1% (141/204) vs 10.6% (25/235).A choledocholithiasis indication for ERCP was associated with more frequent reporting of antibiotic use (42.9%) than that seen with biliary stricture or pancreatic duct indications (Table 2).Conclusion: Despite expert opinion consensus, routine prophylactic antibiotic use for cholangitis prevention during ERCP with SOC reveals overall low adherence rates to these recommendations in our large hospital system.Considerably lower rates were found in our community medical centers compared to academic/tertiary referral centers.A quality improvement initiative will be imperative to raise awareness of increased risks of cholangitis during SOC and recommendations for routine antibiotic use for prevention across our hospital system, in particular among physicians practicing ERCP in the community.