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Emerging Therapies to Prevent Post-ERCP Pancreatitis

Current Gastroenterology Reports volume 22, Article number: 59 (2020) Cite this article

Abstract

Purpose of Review

The aim of this review is to evaluate emerging, novel therapies for the prevention of post-ERCP pancreatitis.

Recent Findings

Rectal indomethacin reduces the risk of pancreatitis in low- and average-risk patients, who comprise the majority of patients undergoing ERCP. An 8-h protocol of aggressive lactated Ringer’s reduces the risk of pancreatitis in average-risk patients. Sublingual nitrate may provide additional benefit to rectal NSAIDs in preventing PEP. A tacrolimus trough > 2.5 ng/mL was recently shown to be associated with a lower risk of PEP in liver transplant patients undergoing ERCP.

Summary

Routine usage of rectal indomethacin in all patients undergoing ERCP reduces the risk of PEP. Pancreatic-duct stents reduce the risk of PEP in high-risk patients. There is emerging data that aggressive hydration with lactated Ringer’s and nitrates may further reduce PEP. Tacrolimus is a promising potential agent to prevent PEP but needs further clinical study.

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Abbreviations

CI:

Confidence interval

ERCP:

Endoscopic retrograde cholangiopancreatography

NSAIDs:

Non-steroidal anti-inflammatory drugs

OR:

Odds ratio

PD:

Pancreatic duct

PEP:

Post-ERCP pancreatitis

RCT:

Randomized control trial

SOD:

Sphincter of Oddi dysfunction

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Affiliations

  1. Division of Gastroenterology and Hepatology, University of California San Francisco, 513 Parnassus Avenue, S-357, Box 0538, San Francisco, CA, 94143-0538, USA

    Nikhil R. Thiruvengadam

  2. Gastroenterology Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Nikhil R. Thiruvengadam & Michael L. Kochman

  3. Center for Endoscopic Innovation, Research and Training, Perelman School of Medicine, Philadelphia, PA, USA

    Michael L. Kochman

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Thiruvengadam, N.R., Kochman, M.L. Emerging Therapies to Prevent Post-ERCP Pancreatitis. Curr Gastroenterol Rep 22, 59 (2020). https://doi.org/10.1007/s11894-020-00796-w

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Keywords

  • Post-ERCP pancreatitis
  • Rectal indomethacin
  • Lactated ringer’s
  • Pancreatic duct stents
  • Tacrolimus