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Review
. 2024 May-Jun;37(3):266-279.
doi: 10.20524/aog.2024.0870. Epub 2024 Mar 14.

Update in preventing post-endoscopic retrograde cholangiopancreatography pancreatitis

Bálint Gellért  1 , Árpád V Patai  1 , István Hritz  1
Affiliations
Review

Update in preventing post-endoscopic retrograde cholangiopancreatography pancreatitis

Bálint Gellért et al. Ann Gastroenterol. 2024 May-Jun.

Abstract

Of all the possible complications associated with endoscopic retrograde cholangiopancreatography (ERCP), acute pancreatitis undoubtedly represents the heaviest burden for patients and healthcare professionals. The overall incidence, ranging from 3.5% to around 10%, and annual estimated costs exceeding $150 million in the USA should signal caution for everyone carrying out ERCP. In-depth knowledge of the risk factors and the pharmacological and endoscopic treatment options is required to avoid this adverse event. In this review, we evaluate the relevant data published in the literature since the appearance of the latest recommendations of the leading gastroenterological societies. Thus, we intend to provide a comprehensive and up-to-date overview of the factors to consider and possible interventions applicable before and after the intervention to prevent the development of post-ERCP pancreatitis.

Keywords: Post-endoscopic retrograde cholangiopancreatography pancreatitis; fluid therapy; nonsteroidal anti-inflammatory drugs; pancreatic stent; prophylaxis.

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Conflict of interest statement

Conflict of Interest: None

Figures

Figure 1
Figure 1
Major pathophysiologic pathways contributing to the development of PEP and possible interventions [41] PPS, prophylactic pancreatic stent; EST, endoscopic sphincterotomy; EPLBD, endoscopic papillary large balloon dilation; DGW, double-guidewire technique; NSAID, nonsteroidal anti-inflammatory drug
Figure 2
Figure 2
Current strategies used in the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis [2] NSAID, nonsteroidal anti-inflammatory drug
Figure 3
Figure 3
The authors recommentations for PEP prophylaxis in light of recent publications ERCP, endoscopic retrograde cholangiopancreatography; PPS, prophylactic pancreatic stent; EST, endoscopic sphincterotomy; EPLBD, endoscopic papillary large balloon dilation; DGW, double-guidewire technique; NSAID, nonsteroidal anti-inflammatory drug; PD, pancreatic duct; AV, aggressive volume; cSEMS, fully covered self-expendable metal stent; PEP, post-ERCP pancreatitis
See this image and copyright information in PMC

References

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