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Update on the Prevention of Post-ERCP Pancreatitis

Current Treatment Options in Gastroenterology volume 16, pages 428–440 (2018)Cite this article

Abstract

Purpose of review

Endoscopic retrograde cholangiopancreatography (ERCP) is a commonly performed procedure to manage pancreaticobiliary disease. Post-ERCP pancreatitis (PEP) is the most common adverse event of ERCP with a significant burden of morbidity and cost.

Recent findings

Appropriate indication and counseling is mandatory especially for patients at increased risk for PEP such as those with suspected sphincter of Oddi dysfunction, pancreatic indications, and a prior history of PEP. Guidewire-facilitated deep cannulation is favored over contrast injection. High-quality trials support the use of rectal administered non-steroidal anti-inflammatory agents and pancreatic duct stent placement for high-risk patients. There is emerging evidence favoring the use of rectal NSAIDs and aggressive hydration in average-risk patients though further studies are required. There is also growing interest in the use of combination therapies as well such as pancreatic stents in combination with NSAIDs.

Summary

The initial step towards PEP prevention involves careful patient selection and informed decision-making. Endoscopists should use several approaches to mitigate the risk of PEP, including guidewire-assisted cannulation, pancreatic stent placement, and rectal NSAIDs use for high-risk patients. The exact role of aggressive hydration and combination therapies needs to be further investigated.

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Affiliations

  1. Department of Medicine, Division of Gastroenterology, Keck School of Medicine, University of Southern California, D & T Building Room B4H100, 1983 Marengo St, Los Angeles, CA, 90033-1370, USA

    Han Zhang MD, Jaehoon Cho MD & James Buxbaum MD, MS

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  1. Han Zhang MD
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  2. Jaehoon Cho MD
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  3. James Buxbaum MD, MS
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Correspondence to James Buxbaum MD, MS.

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This article is part of the Topical Collection on Pancreas

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Zhang, H., Cho, J. & Buxbaum, J. Update on the Prevention of Post-ERCP Pancreatitis. Curr Treat Options Gastro 16, 428–440 (2018). https://doi.org/10.1007/s11938-018-0194-y

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Keywords

  • Pancreatitis
  • ERCP
  • PEP