Prevention of post ERCP pancreatitis:An overview

Abstract

Therapeutic ERCP has become an accepted interventional
method for both biliary and pancreatic diseases despite complications.
Post-ERCP pancreatitis, a complication associated
to the technique and the endoscopist's skills, remains a burning
issue since it has been reported to occur in 2-9% in unselected
prospective series, and up to 30% in some series due
to diverse definitions of post-ERCP pancreatitis and different
methods of data collection. The severity of post-ERCP pancreatitis
can range from a minor inconvenience, to a devastating
illness (0.3% to 0.6% in prospective series) with pancreatic
necrosis, multiorgan failure, permanent disability, and even
death. Patient-related risk factors (i.e. patient indication selection,
young age, sphincter of Oddi dysfunction, female sex, previous
pancreatitis, potentially pancreatotoxic drugs, anatomic
variations) and endoscopy-related factors (precut sphincterotomy,
injection of contrast media into the pancreatic duct, difficulty
of cannulation), have all been reported to increase the
risk of developing post-ERCP pancreatitis. Pharmacological
agents, such as nifedipine, glucagon, calcitonin, n-acetylcysteine,
allopurinol, corticosteroids, low-molecular weight heparin,
gabexate, somatostatin and its analogues, have been proposed
with the indication of avoiding post-ERCP pancreatitis.
Novelties in cannulation techniques and improved equipment,
along with specific endoscopic interventions, as prophylactic
pancreatic stent placement, have also been proposed to effectively
reduce the risk. This review provides an evidence- based
assessment of published data on prevention of post-ERCP pancreatitis
and current suggestions for its avoidance.