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Preventing Post-ERCP Pancreatitis: Update 2016

Current Treatment Options in Gastroenterology volume 14, pages 340–347 (2016)Cite this article

Opinion statement

Post-ERCP remains a major challenge, although significant progress has been made in predicting risk and methods of prevention. Facets of post-ERCP pancreatitis can be divided into the four “P’s”: they are patient-related factors, procedure-related factors, pancreatic stents, and pharmacoprophylaxis. New information about risk factors includes a description of IPMN as a patient-related risk, with smoking and chronic liver disease as protective factors. Procedure-related factors include one or more deep passages of a guidewire into the pancreatic duct as a salient risk, perhaps outweighing difficult cannulation or contrast injection, but one that can be mitigated by placement of a pancreatic stent. In addition, placement of transpapillary metallic stents has emerged as an independent risk for post-ERCP pancreatitis (PEP). Although there has been a rising wave of enthusiasm for rectal NSAIDs as a kind of panacea for prevention of post-ERCP pancreatitis, the newest data question their efficacy in unselected cohorts. Pancreatic stent placement remains the most proven and reliable method of preventing post-ERCP pancreatitis in both mixed- and high-risk ERCP. Success at placement of protective pancreatic stents is a paramount for safety and efficacy, and technical expertise at placing pancreatic stents widely among centers. The use of specialized techniques including very small caliber guidewires and stents is necessary to approach 100 % success.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

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  1. Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, MMC 36, 406 Harvard Street SE, Minneapolis, MN, 55455, USA

    Martin L. Freeman M.D., FACG, FASGE

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  1. Martin L. Freeman M.D., FACG, FASGE
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Correspondence to Martin L. Freeman M.D., FACG, FASGE.

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Martin L. Freeman has received personal fees from Boston Scientific Corporation and XLumena Corporation.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Pancreas

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Freeman, M.L. Preventing Post-ERCP Pancreatitis: Update 2016. Curr Treat Options Gastro 14, 340–347 (2016). https://doi.org/10.1007/s11938-016-0097-8

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  • DOI: https://doi.org/10.1007/s11938-016-0097-8

Keywords

  • Post-ERCP pancreatitis
  • Pancreatic stent
  • Nonsteroidal anti-inflammatory agents (NSAIDS)
  • Endoscopic retrograde cholangiopancreatography (ERCP)