Download PDF
CC BY-NC-ND 4.0 · Journal of Digestive Endoscopy 2012; 03(S 05): 068-070
DOI: 10.4103/0976-5042.95037
Review Article
Society of Gastrointestinal Endoscopy of India

Prevention of post endoscopic retrograde cholangiopancreatography pancreatitis

Nalini M. Guda
GI Research, Aurora St. Luke's Medical Center, Milwaukee, WI, USA
› Author Affiliations
Further Information

Publication History

Publication Date:
26 September 2019 (online)

  PDF Download Permissions and Reprints

Abstract

Post ERCP pancreatitis (PEP) is a common problem. Knowledge of patient and procedure related risk factors along with appropriate measures aimed at reduction of risk have been successful in reducing both the incidence and the severity. Prophylactic pancreatic duct stenting has definitely reduced the incidence and the severity of PEP in high risk patients. There are some emerging data on the use of non steroidal anti inflammatory agents though this is not widely adapted in practice. Key is to avoid procedures with marginal indications and use of non invasive/less invasive procedures.

Key words

ERCP - post ERCP Pancreatitis - pancreatic stents - post ERCP complications
 

  • References

  • 1 Freeman ML, Guda NM. Prevention of post-ERCP pancreatitis: A comprehensive review. Gastrointest Endosc 2004;59:845-64.
  • 2 Cotton PB, Lehman G, Vennes J, Geenen JE, Russell RC, Meyers WC, et al. Endoscopic sphincterotomy complications and their management: An attempt at consensus. Gastrointest Endosc 1991;37:383-93.
  • 3 Freeman ML, Nelson DB, Sherman S, Haber GB, Herman ME, Dorsher PJ, et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med 1996;335:909-18.
  • 4 Masci E, Mariani A, Curioni S, Testoni PA. Risk factors for pancreatitis following endoscopic retrograde cholangiopancreatography: A meta-analysis. Endoscopy 2003;35:830-4.
  • 5 Williams EJ, Taylor S, Fairclough P, Hamlyn A, Logan RF, Martin D, et al. Risk factors for complication following ERCP; results of a large-scale, prospective multicenter study. Endoscopy 2007;39:793-801.
  • 6 Cheng CL, Sherman S, Watkins JL, Barnett J, Freeman M, Geenen J, et al. Risk factors for post-ERCP pancreatitis: A prospective multicenter study. Am J Gastroenterol 2006;101:139-47.
  • 7 Guda NM, Freeman ML. True culprit or guilt by association? Is sphincter of Oddi manometry the cause of post-ERCP pancreatitis in patients with suspected sphincter of Oddi dysfunction, or is it the patients’ susceptibility? Rev Gastroenterol Disord 2004;4:211-3.
  • 8 Freeman ML, Guda NM. ERCP cannulation: A review of reported techniques. Gastrointest Endosc 2005;61:112-25.
  • 9 Choudhary A, Bechtold ML, Arif M, Szary NM, Puli SR, Othman MO, et al. Pancreatic stents for prophylaxis against post-ERCP pancreatitis: A meta-analysis and systematic review. Gastrointest Endosc 2011;73:275-82.
  • 10 Mazaki T, Masuda H, Takayama T. Prophylactic pancreatic stent placement and post-ERCP pancreatitis: A systematic review and meta-analysis. Endoscopy 2010;42:842-53.
  • 11 Singh P, Das A, Isenberg G, Wong RC, Sivak MV Jr, Agrawal D, et al. Does prophylactic pancreatic stent placement reduce the risk of post-ERCP acute pancreatitis? A meta-analysis of controlled trials. Gastrointest Endosc 2004;60:544-50.
  • 12 Freeman ML, Overby C, Qi D. Pancreatic stent insertion: Consequences of failure and results of a modified technique to maximize success. Gastrointest Endosc 2004;59:8-14.
  • 13 Freeman ML. Pancreatic stents for prevention of post-ERCP pancreatitis: For everyday practice or for experts only? Gastrointest Endosc 2010;71:940-4.
  • 14 Brackbill S, Young S, Schoenfeld P, Elta G. A survey of physician practices on prophylactic pancreatic stents. Gastrointest Endosc 2006;64:45-52.
  • 15 Rashdan A, Fogel EL, McHenry L Jr., Sherman S, Temkit M, Lehman GA. Improved stent characteristics for prophylaxis of post-ERCP pancreatitis. Clin Gastroenterol Hepatol 2004;2:322-9.
  • 16 Bakman YG, Safdar K, Freeman ML. Significant clinical implications of prophylactic pancreatic stent placement in previously normal pancreatic ducts. Endoscopy 2009;41:1095-8.
  • 17 Elmunzer BJ, Waljee AK, Elta GH, Taylor JR, Fehmi SM, Higgins PD. A meta-analysis of rectal NSAIDs in the prevention of post-ERCP pancreatitis. Gut 2008;57:1262-7.
  • 18 Otsuka T, Kawazoe S, Nakashita S, Kamachi S, Oeda S, Sumida C, et al. Low-dose rectal diclofenac for prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: A randomized controlled trial. J Gastroenterol 2012. [Epub ahead of print]
  • 19 Katsinelos P, Fasoulas K, Paroutoglou G, Chatzimavroudis G, Beltsis A, Terzoudis S, et al. Combination of diclofenac plus somatostatin in the prevention of post-ERCP pancreatitis: A randomized, double-blind, placebo-controlled trial. Endoscopy 2012;44:53-9.