Background and study aims  Post-ERCP pancreatitis (PEP) is a common adverse event in high-risk patients. Current intervention known to reduce the incidence and severity of PEP include pancreatic duct stent placement, nonsteroidal anti-inflammatory drugs per rectum, and intravenous (IV) fluids. We compared aggressive normal saline (NS) vs aggressive lactated Ringer’s (LR) infusion for the prevention of PEP in high-risk patients undergoing ERCP. Patients and methods  Patients were randomized to receive either an aggressive infusion of NS or LR. The infusion was started at a rate of 3 mL/kg/hr and continued throughout the ERCP procedure. A 20 mL/kg bolus was given at the end of the procedure, then continued at a rate of 3 mL/kg/hr. Results  A total of 136 patients were included in our analysis. The incidence of PEP was 4 % (3/72 patients) in the LR group versus 11 % (7/64 patients) in the NS group resulting in a relative risk (RR) of 0.38 (95 % confidence interval [CI] 0.10 to 1.42; P  = 0.19). The relative risk reduction (RRR) was 0.62 (95 % CI –0.41 to 0.90) along with an absolute risk reduction (ARR) of 0.07 (95 % CI –0.025 to 0.17) and an number needed to treat of 15 (95 % CI –41 to 6). Conclusions  To our knowledge, this is the first study comparing aggressive IV NS to aggressive IV LR in high-risk patients. The incidence of PEP was lower in the group receiving an aggressive LR infusion (4 %) compared to NS infusion (11 %). However, the difference was not statistically significant likely due to poor accrual thereby impacting the power of the study.

Percutaneous mechanical circulatory support (pMCS) devices are increasingly used in patients with cardiogenic shock as a bridge to recovery or bridge to decision to advanced heart failure therapies. Gastrointestinal bleeding (GIB) is a common complication that can be catastrophic. Because of the paucity of data describing the association of GIB with pMCS, we analyzed this population using the United States National Inpatient Sample database. We performed a retrospective study in patients with pMCS devices who had GIB during the index hospitalization using the National Inpatient Sample. Multivariate logistic regression analysis was performed to determine independent predictors of GIB in these patients. A total of 466,627 patients were included. We observed an overall increase in the incidence of adjusted GIB from 2.9% to 3.5% (p = 0.0025) from 2005 to 2014. In comparison to patients without GIB, those with GIB had significantly higher in-hospital mortality, length of stay, and hospitalization cost. In addition to the usual co-morbid conditions, the presence of small bowel and colonic ischemia, colon cancer, diverticulosis, chronic liver disease, and peptic ulcer disease were noted to be significant predictors of GIB for all (p < 0.001). In conclusion, patients with pMCS and GIB have higher in-hospital mortality, longer length of stay, and higher cost of hospitalization. Awareness of patient risk factors for bleeding and gastrointestinal disorders are important before the use of mechanical circulatory support devices because they are associated with a substantially higher risk for bleeding. (C) 2022 Published by Elsevier Inc.

Video capsule endoscopy (VCE) is an innovation that has revolutionized care within the field of gastroenterology, but the time needed to read the studies generated has often been cited as an area for improvement. With the aid of artificial intelligence, various fields have been able to improve the efficiency of their core processes by reducing the burden of irrelevant stimuli on their human elements. In this study, we have created and trained a convolutional neural network (CNN) capable of significantly reducing capsule endoscopy reading times by eliminating normal parts of the video while retaining abnormal ones. Our model, a variation of ResNet50, was able to reduce VCE video length by 47% on average and capture abnormal segments on VCE with 100% accuracy on three VCE videos as confirmed by the reading physician. The ability to successfully pre-process VCE footage as we have demonstrated will greatly increase the practicality of VCE technology without the expense of hundreds of hours of physician annotated videos.

Introduction: Video capsule endoscopy (VCE) is an innovation that has revolutionized care within the field of gastroenterology, but the time needed to read the studies generated has often been cited as an area for improvement. The purpose of this study is to create a machine learning model capable of significantly reducing capsule endoscopy reading times. Methods: In this study, we have trained a convolutional neural network, ResNet50, using videos from the KID dataset to confidently exclude normal images on VCE, while retaining abnormal ones. The CNN was exposed to 3 full length capsule endoscopy videos A threefold cross-validation scheme was employed whereby the model was trained using 2 of the aforementioned videos, tested on the third and this was repeated for all possible video combinations. We trained our model for 9 epochs and further improved the predictions of our model by adding rotated versions of abnormal segments to our training data. Results: Our study identified abnormal frames in 3 KID videos as outlined in the Table. We were able to reduce the video length by 47%, on average, and captured frames from 118 of the 119 abnormal segments labeled by the expert physician. We were able to develop an algorithm that successfully detected 99% of abnormal segments while reducing the reading time for a physician by over 43%. Conclusion: Our model demonstrated high levels of accuracy with significant reduction in physician reading time. Our results are reassuring and demonstrate the benefit of CNN in processing VCE images. We believe our study lays an excellent foundation for further validation in large multicenter trials. Table 1. - Description of the various characteristics of the of the 3 KID videos in addition to the reduced number of frames produced and abnormal segments detected by the ResNet50 model Video Name Total Number of Frames Number of Abnormal Segments Reduced Number of Frames by ResNet50 Number of Abnormal Segments Detected by ResNet50 KID Video 1 28480 (96 min) 22 14828 (49 min) 22 KID Video 2 117565 (391 min) 86 84672 (282 min) 86 KID Video 3 74762 (249 min) 11 27099 (90 min) 11

Gastroparesis is defined as a delay in gastric emptying in the absence of mechanical obstruction. Currently the reference standard for diagnosis is a gastric emptying study (GES). This is a long procedure (up to 4 hours) that requires intake of radiolabeled food. Many patients are unable to tolerate intake of the standard meal due to their symptoms, others are concerned about intake of radioactive isotopes. Capsule endoscopy consists of a pill size camera that visualizes the esophagus, stomach and the small bowel.

Although endoscopic retrograde cholangiopancreatography (ERCP) is the most accepted and effective therapeutic approach for biliary complications following liver transplantation, there is a paucity of data on the safety of ERCP, specifically in the early and delayed transplant period. The aim of our study was to investigate the incidence of post- ERCP related complications in early and delayed setting in patients following orthotopic liver transplantation(OLT). We hypothesized that performing ERCPs in the early transplant period is associated with a significant risk of complications. This study was conducted at our institution after the approval of our institutional review board. Patients who underwent LT from January 2011- December 2018 were included. We performed a retrospective analysis of the data presented in Table 1. A univariable analysis was performed to assess the difference in demographic factors and incidence of complications between subjects who had ERCP < 2 weeks, 2 weeks to 4 weeks and > 4 weeks after OLT. For assessing differences in continuous variables across compared groups one-way analysis of variance was used and Pearson's chi-square for categorical factors. Binary logistic regression analysis was performed to assess the association between time group and occurrence of post-ERCP complications while adjusting for possible confounders. All analyses were performed using SPSS version 25 and a p-value < 0.05 was considered statistically significant A total of 118 subjects are included in the analysis, who underwent a total of 243 ERCPs. Average age was 51 years and 90.1% were male. Demographic and pre- ERCP baseline characteristics were comparable between all groups. A total of 12% of patients had post-ERCP complications (Table 1). The incidence of complications was 9.5% for the late ERCP group versus 20.1% for the early ERCP group (OR 2.4; 95% CI 0.8 to 7.13; p=0.119) and 20.8% for the intermediate ERCP group (OR 2.5; 0.84 to 7.54; p=0.10), which was not statistically significant. Among the types of complications in each group ,the ones who underwent early ERCP, two patients had evidence of biliary perforation and hepatic abscess requiring surgical intervention. Biliary complications are known to be most common complication following OLT. ERCP itself has been associated with complications in 4%-12% of cases; which is similar to the findings in our study(12%). Our study also shows that although the overall complication rate was not different in the early, intermediate, and late groups, the types of complications were different. There were an increased number of biliary leaks and abscesses related to ERCP in the early ERCP group. Caution should thus be exerted in performing ERCP within the first month post-transplant and it should be postponed until after thirty days if possible

INTRODUCTION: Esophageal intramural pseudodiverticulosis (EIPD) is a rare disorder characterized by the appearance of multiple small flask-shaped lesions of the esophageal wall. Inflammation of the submucosal glands can cause fibrosis and eventual stricture formation. Here we review a case of EIPD due to recurrent candida esophagitis complicated by esophageal lumenal narrowing. CASE DESCRIPTION/METHODS: The patient is a 48 year old woman who was admitted for hematemesis. She has a complicated medical history of untreated hepatitis C, HIV/AIDS, thrombocytopenia secondary to HIV, recurrent esophageal candidiasis, severe esophagitis and gastritis. She had a history of noncompliance with medications. On admission she had a hemoglobin 4.4, MCV 67.9, platelets 8, WBC 6.7. She received appropriate transfusions and underwent endoscopy. Diffuse white plaques were seen throughout the esophagus along with severe esophagitis (Figure 1), and a benign appearing intrinsic stricture was found at 16cm from the incisors measuring 9 mm in diameter which required downsizing of scope to traverse. This stricture was dilated up to 36Fr. Esophageal biopsies were consistent with Candida esophagitis. Repeat endoscopy for re-treatment was completed 2 days later and diffuse severe mucosal changes consistent with pseudo-diverticulosis were found (Figure 2). The esophageal stricture (Figure 3) was found again and dilation was performed to 45Fr. She completed a 1 month course of fluconazole. Repeat endoscopy one month later showed candida esophagitis and EIPD, but resolution of stenosis. DISCUSSION: Esophageal intramural pseudodiverticulosis (EIPD) is a rare condition with unclear etiology and pathogenesis, although some theorize that chronic inflammation or motility issues may contribute. It has been associated with diabetes mellitus, HIV, alcoholism, gastroesophageal reflux, candidiasis, infectious esophagitis, achalasia, and other motor disorders. Diagnosis is often made during endoscopy or found on imaging such as barium esophageal studies. Stricture development particularly in upper or mid esophagus can occur in up to 50% of patients. Risk of squamous cell carcinoma has also been reported. Conservative management is the treatment of choice, although endoscopic therapy with bougienage dilation is sometimes required, often with repeat dilation. This case highlights a common complication in an uncommon condition. This patient required repeat bougienage dilation, but it is important to remember treatment of underlying etiology is key.Figure 1.: Esophagus with diffuse white plaques of Candida.Figure 2.: Esophagus showing multiple diverticuli of EIPD.Figure 3.: Esophagus with numerous psuedodiverticuli and stricture with EIPD.

Background and Aims: ERCP is considered the first-line therapy for biliary duct leaks (BDLs). However, the optimal ERCP timing and endotherapy methods remain controversial. Our aim was to evaluate these factors as predictors of poor clinical outcomes after BDLs. Methods: Adults who underwent ERCP for BDLs after cholecystectomy were identified from the Nationwide Inpatient Sample from 2000 to 2014. ERCP was classified as emergent, urgent, and expectant if it was done within 1 day, after 2 to 3 days, or >3 days after BDLs, respectively. Endotherapy was classified into sphincterotomy, stent, or combination. Post-ERCP adverse events (AEs) were defined as requiring pressor infusion, endotracheal intubation, invasive monitoring, or hemodialysis. Early endotherapy failure was defined as the need for salvage surgical or radiology-percutaneous biliary intervention after ERCP. Results: A total of 1028 patients with a median age of 56 years were included. ERCP was done emergently (19%), urgently (30%), and expectantly (51%). Endotherapy procedures were sphincterotomy (24%), biliary stent (24%), and combination (52%). Post-ERCP AEs were 11%, 10%, and 9% for emergent, urgent, and expectant ERCP, respectively (P = .577). In-hospital mortality showed a U-shape trend of 5%, 0%, and 2% for emergent, urgent, and expectant ERCP, respectively (P < .001). Combination and stent monotherapy had lower failure rates of 3% and 4%, respectively as compared with sphincterotomy monotherapy with failure rate of 11% (P < .001). When multivariate analysis was used, both combination (odds ratio, .2; 95% confidence interval, .1-.5) and stent monotherapy (odds ratio, .4; 95% confidence interval, .2-.9) were less likely to fail as compared with sphincterotomy monotherapy. There were no statistically significant differences between combination therapy and stent monotherapy in the univariate and the multivariate analyses. Conclusions: Although limited by retrospective design and the possibility of selection bias, this analysis suggests that the timing of ERCP is not a significant predictor of post-ERCP AEs after BDLs. Furthermore, combination or stent monotherapy had lower failure rates as compared with sphincterotomy monotherapy.

OBJECTIVES:Percutaneous gastrostomy tube placement is performed in patients requiring long-term enteral nutrition. Although both endoscopic and fluoroscopic techniques may be used, there are inherent risks and potential complications associated with both procedures that are not generally known to referring physicians. The purpose of this study was to compare and contrast indications for placement and procedurally related complications between fluoroscopic and endoscopic gastrostomy tubes techniques at a tertiary care facility.METHODS:A retrospective cohort study was performed. All consecutive patients with either percutaneous endoscopic (PEG) or percutaneous radiologic (PRG) gastrostomy tube placement between October 2011 and January 2013 were eligible for inclusion. Basic demographic information, American Society of Anesthesiologists score, procedure indication, laboratory data, and use of anticoagulation were recorded. Both direct and indirect procedural complications were documented if they occurred 30 days after gastrostomy tube placement, and were classified and scored based on severity and need for further intervention.RESULTS:A total of 297 patients met the inclusion criteria, 150 of whom had gastrostomy tubes placed fluoroscopically and 147 of whom had them placed endoscopically. There was no statistically significant difference in direct complications within the first 30 days (PEG 6.8% vs PRG 8%); however, the type of complication observed varied between the two groups. Although superficial wound infections and buried bumpers were more common in the PEG group, bleeding was more common in the PRG group.CONCLUSIONS:Placement of gastrostomy tubes either endoscopically or fluoroscopically is relatively safe with similar indications. Although the complication rate between the two groups was not significant, the types of procedural complications observed did vary.

The recombinant zoster vaccine (Shingrix) was approved to help combat the incidence of shingles in patients age 50 years and older and the CDC now recommends it over the zoster vaccine live (Zostavax). This article highlights practical considerations to help clinicians appropriately apply the most recent vaccine recommendations to their patients.

INTRODUCTION: Approximately 5–10% of patients who present with an acute gastrointestinal (GI) hemorrhage have a primary small bowel source. While small bowel angioectasias are one of the most common causes of small bowel hemorrhage, it is rare to find large vascular anomalies in the small bowel as a cause of chronic GI bleed. CASE DESCRIPTION/METHODS: We present a case of a 56-year-old woman referred to our institution for management of obscure GI bleeding, associated with severe iron deficiency anemia. She had intermittent melena and occasional dark red blood mixed with stool. Extensive work up in an outside facility including 2 endoscopies, 2 colonoscopies, and a capsule endoscopy were unrevealing. After referral to our institution; push enteroscopy, colonoscopy and retrograde single balloon enteroscopy were performed and were negative for source of bleeding. Capsule endoscopy revealed a small oozing angioectasia in proximal jejunum. The lesion was treated with heater probe via anterograde single-balloon enteroscopy. Due to persistent melena and anemia, antegrade balloon enteroscopy was repeated and demonstrated an abnormal cluster of vascular-appearing lesions in the proximal jejunum that were marked with two hemostatic clips. CT angiogram was consistent with a large arteriovenous malformation (AVM). Interventional radiology performed glue embolization of the high-flow jejunal arteriovenous malformation. The post procedure course was complicated by ischemic proximal jejunum which was confirmed on repeat enteroscopy. Fortunately, her symptoms completely resolved with conservative management without surgical intervention. DISCUSSION: AVMs are abnormal lesions with a direct connection between the arterial and venous blood supply without any true capillary bed connecting them. While extremely rare within the GI tract, they can cause significant amount of bleeding and must be considered in patients with obscure GI bleeding or chronic iron deficiency anemia. Studies have shown that AVMs typically only account for 1–2% of upper GI bleeds. More common sites for AVMs include the cecum and ascending colon, while other sites like the small bowel are much more rare. Diagnostic work up typically begins with upper endoscopy followed by colonoscopy. However, these tests are often unrevealing when dealing with small bowel AVMs. Patient’s typically undergo capsule endoscopy for further evaluation, as seen in our patient. If the source of bleeding is still un-identified, then angiography or bleeding scans may be required.

Helicobacter pylori is a chronic bacterial infection that can lead to peptic ulcer disease, chronic gastritis, and gastric cancer. Its prevalence in the United States is lower than in most of the world, although specific populations are at particular risk for disease-related complications, including those with lower socioeconomic status and older adults. Since its discovery, there have been advances in H. pylori diagnosis and treatment, which are the focus of this review for general practice. Practice guidelines have expanded the role for treatment, despite traditional management algorithms resulting in diminished effectiveness as a result of increasing antibiotic resistance. In this context, new approaches warrant discussion. As such, this review aims to provide a clinical context and framework for the testing and rational treatment of H. pylori infection consistent with the available evidence.

Gastroesophageal reflux disease (GERD) is a common chronic disorder in industrialized countries. Gastroesophageal reflux disease is one of the most frequent diseases encountered by primary care providers. The primary symptoms of GERD include heartburn, regurgitation, globus sensation, dysphagia, chest pain, and belching. If symptoms are left untreated, a major concern is complications and the potential risk of esophageal adenocarcinoma associated with GERD. With the increasing prevalence and incidence of GERD and the increasing cost of this disease, there is a need for advanced practice registered nurses to understand the nature of GERD including its pathophysiology, signs and symptoms, and treatment options to address the disease.

Objectives Obscure overt gastrointestinal bleeding can be challenging to evaluate in patients with electronic cardiac devices such as continuous flow left ventricular assist devices (LVADs), pacemakers (PPMs), and implantable cardioverter defibrillators (ICDs). Limited data exist on the utility and safety of single balloon enteroscopy (SBE) in patients with cardiac devices. We aimed to evaluate the safety, efficacy, diagnostic, and therapeutic outcomes of the aforementioned devices in patients undergoing SBE. Methods A retrospective study was performed using the medical records of 57 patients undergoing SBE at our institution from 2010 to 2014. Patients were divided into two groups: those with cardiac devices and those without. Data on comorbidities, complications, findings, diagnostic, and therapeutic yield were compared. t Test and logistic regression assessed the association between dependent and independent variables. For continuous data, the results were summarized as mean difference and standard deviation. For dichotomous data, the results were summarized as odds ratio and 95% confidence intervals. Results The overall age in patients with cardiac devices was 67.89 ± 6.96 versus 66.03 ± 11.95 years in the control. The cardiac device group was composed of 42.1% women; the control comprised 21.1% women. There were 19 patients with cardiac devices; 8 (LVAD + ICD), 1 (LVAD + PPM + ICD), 2 (PPM + ICD), 6 (PPM), 2 (ICD); 38 patients were in the control group. Patients with cardiac devices were hospitalized more often than patients without devices; this finding was not statistically significant (odds ratio 1.826, 95% confidence interval 0.544–6.128, P = 0.389). Procedure times were longer in the cardiac device group, 65.16 ± 49.92 minutes, when compared with the control, 57.40 ± 20.42, but it also did not reach statistical significance (mean difference 7.758, 95% confidence interval −11.360 to 26.876, P = 0.049). There was no statistically significant difference in major or minor events between patients with cardiac devices and the control group. Diagnostic and therapeutic yield and rebleeding rates were similar across both groups. Conclusions Patients in the cardiac device group did not appear to be at any more significant risk than those without cardiac devices. Furthermore, diagnostic and therapeutic yield and rebleeding rates appear to be similar across both groups. Clinicians may perform SBE in these patients safely and effectively, with good overall outcomes.

In Brief The recombinant zoster vaccine (Shingrix) was approved to help combat the incidence of shingles in patients age 50 years and older and the CDC now recommends it over the zoster vaccine live (Zostavax). This article highlights practical considerations to help clinicians appropriately apply the most recent vaccine recommendations to their patients. The recombinant zoster vaccine (Shingrix) was approved to help combat the incidence of shingles in patients age 50 years and older and the CDC now recommends it over the zoster vaccine live (Zostavax). This article highlights practical considerations to help clinicians appropriately apply the most recent vaccine recommendations to their patients.

Introduction: Magnetic resonance cholangiopancreatography (MRCP) is an important diagnostic tool in evaluating patients with biliary laboratory abnormalities after orthotopic liver transplant (OLT) to determine the need for more invasive procedures, such as endoscopic retrograde cholangiopancreatography (ERCP), which can deliver therapeutic interventions. The aim of this study was to determine the diagnostic accuracy of MRCP findings using ERCP as the gold standard in a group of post-OLT patients. Methods: A retrospective review of 273 patients who underwent OLT at the University of South Florida and Tampa General Hospital, Tampa, Florida, USA, from January 2012–April 2015 was performed. A total of 52 patients who had a MRCP and underwent a subsequent ERCP were studied. Presence of anastomotic stricture, common bile duct dilation >0.7 mm, bile leak, stone, intrahepatic stricture, or extrahepatic stricture on either modality was recorded. SPSS statistical analysis software (version 22 for Windows, SPSS Inc., Chicago, Illinois, USA) was used to calculate diagnostic accuracy. Results: The mean age of the population examined was 54.5±10.5 years; 73% of the patients were male (38 of 52). Overall agreement between the two procedures ranged from 71–96%. The sensitivity, specificity, and positive and negative predictive values of MRCP for anastomotic strictures were 77%, 59%, 79%, and 56%, respectively. The sensitivity, specificity, and positive and negative predictive values of MRCP for common bile duct dilation of >0.7 mm were 64%, 95%, 82%, and 88%, respectively. Conclusion: Despite significant improvement in the technology to better visualise the biliary system on MRCP, this study found that MRCP does not appear to be sensitive or specific in this chosen population. ERCP should be considered to confirm all positive MRCP findings, and in normal MRCP cases if there are other clinical data suggesting biliary abnormalities.

Effectiveness of colonoscopy as a screening tool for colorectal cancer prevention depends on the quality of bowel preparation. The type of bowel preparation agent prescribed is largely dependent on the prescriber's preference, indicating a lack of standard. A retrospective study (N = 84) compared the quality of bowel preparation using 2-L split-dose polyethylene glycol prep (MoviPrep) to other standard bowel preparations. Colonic mucosa visualized using the Boston Bowel Preparation Scale, cecal intubation indicating successful completion of colonoscopy, scope withdrawal time, and procedure duration were measured as outcomes. Gastroenterologists from one academic practice prescribed 2-L split-dose bowel preparation (MoviPrep) (Group A) compared with Group B that did not prescribe MoviPrep. Results of an independent t test between the 2 provider groups demonstrated a statistically significant difference in colon visualization based on Boston Bowel Preparation Score (t [40] = - 2.1, p = .035). Similar statistically significant results were seen within Group A, which received 2-L split-dose polyethylene glycol bowel preparation and other preparations (t [61] = - 2.55, p = .013). All patients had successful completion of colonoscopy, with no statistical difference in procedure duration and scope withdrawal time. Future studies should confirm the benefits of 2-L split-dose polyethylene glycol preparation for improved colon visualization during screening colonoscopy.

The prevention of post-ERCP pancreatitis (PEP) has evolved considerably over the years. The use of prophylactic pancreatic duct stents and rectal indomethacin are known to decrease rates of PEP. Recently, there has been increased study on periprocedural intravenous fluid (IVF) hydration during ERCP to prevent PEP. Specifically, the amount and type of IVF may impact the rates of PEP. The purpose of this ongoing, prospective study is to compare the efficacy of high volume lactated ringer’s (LR) to high volume normal saline (NS) given peri-procedurally to prevent PEP, particularly in patients at high risk of developing PEP (i.e. SOD, precut sphincterotomy, >8 cannulation attempts). This is a randomized, double-blinded, controlled trial being conducted at Tampa General Hospital. Enrollment started 8/2017 and is ongoing. Patients with active pancreatitis, clinically volume- overloaded and over the age of 75 were excluded. Patients were randomized (1:1) to receive either NS or LR infusion. The infusion was started pre-procedurally at 3 mL/kg/hr and continued throughout the procedure. A 20 mL/kg bolus was given at the end of the procedure and the infusion was then continued at 3 mL/kg/hr. Hospitalized patients continued this infusion for 8 hours. All patients were given 100mg rectal indomethacin prior to the ERCP. Pancreatic duct stents were placed at the discretion of the endoscopists. Depending on inpatient/outpatient status, patients were evaluated after the procedure either at bedside or via telephone to determine if pancreatitis had occurred. The widely accepted consensus definition of PEP was having 2 of 3 of the following: (1) new or worsening abdominal pain clinically consistent with acute pancreatitis, (2) associated pancreatic enzymes elevation ≥ 3 times the upper limit of normal 24 hours after the procedure, and (3) resultant or prolongation of existing hospitalization of ≥ 2 nights. To date, 38 patients have been included in our study, with 22 patients (58%) in the LR group and 16 patients (42%) in the NS group. 51% of the study population was female, 49% was male, and the average age was 56. Thirty patients (75%) were at high risk for developing PEP based on patient and procedure related risk factors. Indications for ERCP are listed in table 1. The overall rate of PEP was 2.6%. The rate of PEP between the NS and LR group was not statistically significant (6.25% vs. 0%, p=0.24). In those at high risk of developing PEP, again, there was no statistically significant difference in the PEP rate between NS and LR (9.1% vs 0%, p=0.18). In patients receiving rectal indomethacin, both NS and LR are equally effective in prevention of PEP when given at high rates, particularly in those at high risk of developing PEP.Tabled 1Indications for ERCP in Study PopulationIndicationLactated RingerNormal Saline GroupTotalAmpullary adenoma112Evaluation for stricture213CBD and PD dilation123Choledocholithiasis639Stent placement, exchange, or removal8513RUQ pain101Known Sphincter of Oddi dysfunction101Evaluation for cholangiocarcinoma011History of FAP (ampullary screening)101Elevated bilirubin011Past episodes of pancreatitis with unknown etiology022Evaluation for suspected periampullary mass101Total221638 Open table in a new tab Tabled 1Table 1. Comparison of Post-ERCP Pancreatitis Rates in Lactated Ringer's and Normal Saline IVF GroupsAll patients:Occurrence of PEPLactated RingerNormal Saline GroupTotalp-valueNo221537Yes011Total221638p=0.235High risk patient subset analysis:Occurrence of PEPLactated RingerNormal Saline GroupTotalp-valueNo191029Yes011Total191130p=0.181 Open table in a new tab