Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis: What We Already Know.

Adham E Obeidat,Ratib Mahfouz,Gabriel Monti,Landon Kozai,David Hernandez,Mahmoud M Mansour,Mohammad Darweesh,Ahmad Alqam

doi:10.7759/cureus.21773

Abstract

Acute pancreatitis is the most common serious complication of endoscopic retrograde cholangiopancreatography (ERCP) resulting in significant morbidity and occasional mortality. Post-ERCP pancreatitis (PEP) has been recognized since ERCP was first performed, and many studies have shown a consistent risk that must be balanced against the many benefits of this procedure. This review will discuss the pathogenesis, epidemiology, potential risk factors, and clinical presentation of PEP. Moreover, it will discuss in detail the most recent updates of PEP prevention and management.

Highlights

BackgroundSince the introduction of endoscopic retrograde cholangiopancreatography (ERCP) in 1968, it has been used as a diagnostic and therapeutic procedure for multiple biliary and pancreatic diseases
PostERCP pancreatitis (PEP) was originally defined as a clinical syndrome of abdominal pain and elevated serum amylase, at least three times the upper level of normal, which occurs more than one week after ERCP for any reason [1,2,3]
Chen et al have reported in a meta-analysis of 13 studies involving 32,381 post-ERCP patients that female gender, previous PEP, previous pancreatitis, endoscopic sphincterotomy, precut sphincterotomy, sphincter of Oddi dysfunction (SOD), and non-prophylactic pancreatic duct stent are significantly associated with an increased risk of PEP [12]

Summary

Introduction

Since the introduction of endoscopic retrograde cholangiopancreatography (ERCP) in 1968, it has been used as a diagnostic and therapeutic procedure for multiple biliary and pancreatic diseases. Chen et al have reported in a meta-analysis of 13 studies involving 32,381 post-ERCP patients that female gender, previous PEP, previous pancreatitis, endoscopic sphincterotomy, precut sphincterotomy, sphincter of Oddi dysfunction (SOD), and non-prophylactic pancreatic duct stent are significantly associated with an increased risk of PEP [12]. A number of techniques and approaches can be used to decrease the probability of developing PEP, including careful use of electrocautery current during sphincterotomy, prophylactic pancreatic stent (PPS) placement in patients who are at a high risk of developing PEP, and wire-guided techniques for deep biliary cannulation. A recent meta-analysis including 11 RCTs studied the benefits of N-acetylcysteine, selenite, beta-carotene, allopurinol, and pentoxifylline in preventing PEP and concluded that antioxidative supplements do not have a beneficial effect in reducing the incidence of PEP [91]. A prospective case-control study of 160 patients concluded that 5-FU added in meglumine diatrizoate can decrease the incidence of PEP and hyperamylasemia [92]

Conclusions

Findings

Disclosures