Abstract ID: A325
CHUS, Sherbrooke, QC, Canada
Background: Few cases of ERCP-related CM adverse reactions have been reported in the current literature. Patients known for any allergy or a prior allergy-like reaction to CM are considered at higher risk of CM adverse reaction. There is a lack of standardisation in practice regarding premedication prophylaxis for at risk patients undergoing ERCP and few data to guide the practitioners.
Aims: Our goal is to evaluate the risk of CM allergic like reaction in a group of patients with a past-history of reaction to iodine product undergoing ERCP.
Methods: A retrospective chart review study was performed of all adult patients who underwent ERCP at our single centre from January 2010 to December 2015. Data regarding demographics, history of allergy (especially iodine), ERCP indication and post-ERCP anaphylactoid reaction were collected for all patients. Additional data were collected for patients with a past-history of reaction to iodine product: hospitalisation status, premedication prophylaxis (corticosteroid and antihistaminic), type of contrast used, post-ERCP time of observation and any ERCP related CM reaction. Severe reaction was defined as an anaphylactic shock or an allergic-like reaction with hypotension or respiratory distress.
Results: Among 1766 patients, 2295 ERCP were performed from 2010 to 2015. 828 (36.1%) ERCP were performed on patients with a past history of any allergy and 127 (5.5%) on patients with prior iodine adverse reaction. Among 2295 ERCP, no anaphylactoid or severe adverse reaction occurred. 1 (0.04%) ERCP-related CM benign reaction was reported in a patient known for penicillin allergy but no prior CM reaction; he had a delayed diffuse pruritic rash with a favorable response to medical treatment. Among 1766 patients, 75 were known for prior reaction to iodine product. Previous iodine reactions were rash (n=22), oedema (n=16), severe CM reaction (n=10) or other-not specified (n=27). Among 127 ERCP performed on these patients, 121 procedures were done without and 6 with a premedication prophylaxis. In both groups, no ERCP-related CM reaction occurred.
Conclusions: To our knowledge, we report the largest cohort of iodine allergic patients undergoing ERCP ever published. Among a group of patients known for prior iodine reaction, 121 ERCP were performed without premedication and no CM adverse reaction were reported. Moreover, among 2295 procedures performed, no severe ERCP-related CM adverse reaction occurred and only 1 (0.04%) benign reaction was reported. These results suggest that ERCP-related CM adverse reactions are very rare even among patients at risk for CM reaction. Therefore, we suggest CM premedication prophylaxis for ERCP should not be given routinely among patients with a past-history of CM reaction.