⁎⁎Invited to participate in the Poster Session of the ASGE meeting.3392 Refeeding patients after endoscopic sphincterotomy: waiting or not waiting ?

Background: After endoscopic sphincterotomy, refeeding is usually delayed for 1 or 2 days after ERCP. The aim of this study was to investigate the necessity of delayed refeeding in patients undergoing endoscopic biliary or pancreatic sphincterotomy (EBPS). Methods: From November 1998 to September 1999, 60 patients with previous normal alimentation were prospectively randomised after EBPS in two groups. Patients belonging to the goup A were allowed for early refeeding (6 hours delayed) whereas patients belonging to the group B were asked to wait the following day before refeeding. Results: The two groups were comparable for age (67 vs 66 years old), levels of serum amylase and lipase before ERCP, indication of ERCP (pancreatic cancer, common bile duct stone, cholangitis, sphincter of Oddi dysfunction, acute or chronic pancreatitis). No difference could be shown concerning the precut papillotomy rate, the biliary or pancreatic stenting rate, the rate of removed choledocal stones, the need for endoscopic hemostasis. Two patients (one in each group) were excluded few hours after randomisation for severe acute pancreatitis. 16 (27.6 %) out of the 58 remaining patients suffered from abdominal pain after ERCP. 13 of them healed with paracetamol infusion and 3 needed morphinic infusion. The paracetamol consumption in group A was significantly lower than in group B (2 vs 11, p = 0.007). In group A, no patient suffered from nausea or vomiting and only one experienced pain during refeeding, requiring paracetamol administration. No statistical difference was shown regarding to the serum level of amylase and lipase after ERCP. The duration of hospital stay was decreased in patients with early refeeding without reaching statistical significance (group A: 2.9 days and group B: 4.1 days, p = 0.15). Conclusion: Early refeeding is well tolerated and decreases significantly the need for paracetamol after endoscopic sphincterotomy. A trend toward a decrease of the duration of the hospital stay was observed in this study.