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Prevention of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis

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Gastrointestinal and Pancreatico-Biliary Diseases: Advanced Diagnostic and Therapeutic Endoscopy

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Abstract

Post-ERCP pancreatitis accounts for more than 50% of ERCP-related complications and results in substantial morbidity and increased health-care expenditures. Major research efforts and some public health initiatives have been directed toward the prevention of this complication and have helped but not eliminated the problem. An evidence-based approach to preventing post-ERCP pancreatitis includes (i) thoughtful patient selection, reserving the procedure for patients with a high likelihood of therapeutic intervention; (ii) risk stratification using validated patient and procedure-related predictors to guide clinical decision-making and the implementation of prophylactic interventions; (iii) sound procedural technique, including wire-guided cannulation, avoidance of repeated/aggressive pancreatography, and early use of alternative cannulation methods in difficult cases; (iv) prophylactic pancreatic stent placement in high-risk cases; and (v) rectal NSAIDs and aggressive lactated ringer’s solution administration in high-risk cases and perhaps in all patients undergoing ERCP. Ongoing and future research initiatives as well as more widespread implementation of evidence-based prevention strategies will further decrease the incidence of this potentially devastating complication.

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Author information

Authors and Affiliations

  1. Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark

    Bonna Leerhøy

  2. Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, SC, USA

    B. Joseph Elmunzer

Authors
  1. Bonna Leerhøy
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  2. B. Joseph Elmunzer
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Correspondence to B. Joseph Elmunzer .

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Editors and Affiliations

  1. Gastrointestinal Endoscopy Unit, Vita-Salute San Raffaele University, MILANO, Milano, Italy

    Pier Alberto Testoni

  2. Digestive Diseases Center, Showa University Hospital, Tokyo, Japan

    Haruhiro Inoue

  3. Div. of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA

    Michael B. Wallace

Section Editor information

  1. Gastrointestinal Endoscopy Unit, Vita‐Salute San Raffaele University, Milan, Italy

    Pier Alberto Testoni

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Leerhøy, B., Elmunzer, B.J. (2020). Prevention of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis. In: Testoni, P.A., Inoue, H., Wallace, M.B. (eds) Gastrointestinal and Pancreatico-Biliary Diseases: Advanced Diagnostic and Therapeutic Endoscopy. Springer, Cham. https://doi.org/10.1007/978-3-030-29964-4_69-1

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  • DOI: https://doi.org/10.1007/978-3-030-29964-4_69-1

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