Post-ERCP Pancreatitis Prevention

  • Mariano Gonzalez-Haba
  • Uzma D. SiddiquiEmail author


Post-ERCP pancreatitis (PEP) is one of the most feared complications of ERCP. Despite being mild in most cases, severe cases of PEP can lead to significant morbidity and even mortality. Many studies have looked at identifying high-risk features related to both the patient and the ERCP procedure itself that may impact on rates of PEP. Strategies that have been demonstrated to decrease the incidence and severity of PEP include aggressive hydration, prophylactic pancreatic duct stenting, and administration of rectal indomethacin. Although these measures have improved clinical outcomes, the best method of preventing PEP is to properly select patients for ERCP by having a solid indication so that unnecessary procedures can be avoided.


Pancreatitis Pancreatic stents NSAID Indomethacin Sphincterotomy Precut Cannulation Sphincter of Oddi dysfunction Injection 



Conflicts of interest: None

Financial disclosures: None

Funding/Grant Support: None

Writing Assistance: None

Author(s) have nothing to disclose. All author(s) disclose that there are NO potential conflicts (financial, professional, or personal) that are relevant to the manuscript.

Supplementary material

Video 12.1

In this video demonstration, a prophylactive pancreatic duct (PD) stent (5 Fr diameter, 3 cm length, single pigtail without any internal flange) is placed to assist with a difficult biliary cannulation and to prevent post-ERCP pancreatitis (PEP). Once the PD stent has been deployed, a needle knife is used to perform a precut to gain access to the bile duct and then the biliary sphincterotomy is completed using a standard sphincterotome. Finally, a biliary stent is placed with good drainage of bile coming through it at the end of the procedure. (MP4 372069 kb).


  1. 1.
    McCune WS, Shorb PE, Moscovitz H. Endoscopic cannulation of the ampulla of Vater: a preliminary report. Ann Surg. 1968;167(5):752–6.PubMedPubMedCentralCrossRefGoogle Scholar
  2. 2.
    Peery AF, Dellon ES, Lund J, Crockett SD, McGowan CE, Bulsiewicz WJ, et al. Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology. 2012;143(5):1179–87 e1–3.PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    Cotton PB, Garrow DA, Gallagher J, Romagnuolo J. Risk factors for complications after ERCP: a multivariate analysis of 11,497 procedures over 12 years. Gastrointest Endosc. 2009;70(1):80–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Freeman ML. Adverse outcomes of ERCP. Gastrointest Endosc. 2002;56(6 Suppl):S273–82.PubMedCrossRefGoogle Scholar
  5. 5.
    Freeman ML, Nelson DB, Sherman S, Haber GB, Herman ME, Dorsher PJ, et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med. 1996;335(13):909–18.PubMedCrossRefGoogle Scholar
  6. 6.
    Kochar B, Akshintala VS, Afghani E, Elmunzer BJ, Kim KJ, Lennon AM, et al. Incidence, severity, and mortality of post-ERCP pancreatitis: a systematic review by using randomized, controlled trials. Gastrointest Endosc. 2015;81(1):143–9. e9.PubMedCrossRefGoogle Scholar
  7. 7.
    Jena AB, Seabury S, Lakdawalla D, Chandra A. Malpractice risk according to physician specialty. N Engl J Med. 2011;365(7):629–36.PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    Hernandez LV, Klyve D, Regenbogen SE. Malpractice claims for endoscopy. World J Gastrointest Endosc. 2013;5(4):169–73.PubMedPubMedCentralCrossRefGoogle Scholar
  9. 9.
    Cotton PB. Analysis of 59 ERCP lawsuits; mainly about indications. Gastrointest Endosc. 2006;63(3):378–82. quiz 464.PubMedCrossRefGoogle Scholar
  10. 10.
    Adler DG, Lieb II JG, Cohen J, Pike IM, Park WG, Rizk MK, et al. Quality indicators for ERCP. Gastrointest Endosc. 2015;81(1):54–66.PubMedCrossRefGoogle Scholar
  11. 11.
    Freeman ML, DiSario JA, Nelson DB, Fennerty MB, Lee JG, Bjorkman DJ, et al. Risk factors for post-ERCP pancreatitis: a prospective, multicenter study. Gastrointest Endosc. 2001;54(4):425–34.PubMedCrossRefGoogle Scholar
  12. 12.
    Cotton PB, Lehman G, Vennes J, Geenen JE, Russell RC, Meyers WC, et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc. 1991;37(3):383–93.PubMedCrossRefGoogle Scholar
  13. 13.
    Gottlieb K, Sherman S. ERCP and biliary endoscopic sphincterotomy-induced pancreatitis. Gastrointest Endosc Clin N Am. 1998;8(1):87–114.PubMedGoogle Scholar
  14. 14.
    Christoforidis E, Goulimaris I, Kanellos I, Tsalis K, Demetriades C, Betsis D. Post-ERCP pancreatitis and hyperamylasemia: patient-related and operative risk factors. Endoscopy. 2002;34(4):286–92.PubMedCrossRefGoogle Scholar
  15. 15.
    Masci E, Toti G, Mariani A, Curioni S, Lomazzi A, Dinelli M, et al. Complications of diagnostic and therapeutic ERCP: a prospective multicenter study. Am J Gastroenterol. 2001;96(2):417–23.PubMedCrossRefGoogle Scholar
  16. 16.
    Sutton VR, Hong MK, Thomas PR. Using the 4-hour Post-ERCP amylase level to predict post-ERCP pancreatitis. JOP. 2011;12(4):372–6.PubMedGoogle Scholar
  17. 17.
    Dumonceau JM, Andriulli A, Elmunzer BJ, Mariani A, Meister T, Deviere J, et al. Prophylaxis of post-ERCP pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Guideline—updated June 2014. Endoscopy. 2014;46(9):799–815.PubMedCrossRefGoogle Scholar
  18. 18.
    Artifon EL, Chu A, Freeman M, Sakai P, Usmani A, Kumar A. A comparison of the consensus and clinical definitions of pancreatitis with a proposal to redefine post-endoscopic retrograde cholangiopancreatography pancreatitis. Pancreas. 2010;39(4):530–5.PubMedCrossRefGoogle Scholar
  19. 19.
    Sultan S, Baillie J. What are the predictors of post-ERCP pancreatitis, and how useful are they? JOP. 2002;3(6):188–94.PubMedGoogle Scholar
  20. 20.
    Thomas PR, Sengupta S. Prediction of pancreatitis following endoscopic retrograde cholangiopancreatography by the 4-h post procedure amylase level. J Gastroenterol Hepatol. 2001;16(8):923–6.PubMedCrossRefGoogle Scholar
  21. 21.
    Anderson MA, Fisher L, Jain R, Evans JA, Appalaneni V, Ben-Menachem T, et al. Complications of ERCP. Gastrointest Endosc. 2012;75(3):467–73.PubMedCrossRefGoogle Scholar
  22. 22.
    Freeman ML, Guda NM. Prevention of post-ERCP pancreatitis: a comprehensive review. Gastrointest Endosc. 2004;59(7):845–64.PubMedCrossRefGoogle Scholar
  23. 23.
    Pezzilli R, Romboli E, Campana D, Corinaldesi R. Mechanisms involved in the onset of post-ERCP pancreatitis. JOP. 2002;3(6):162–8.PubMedGoogle Scholar
  24. 24.
    Sinha A, Cader R, Akshintala VS, Hutfless SM, Zaheer A, Khan VN, et al. Systemic inflammatory response syndrome between 24 and 48 h after ERCP predicts prolonged length of stay in patients with post-ERCP pancreatitis: a retrospective study. Pancreatology. 2015;15:105–10.PubMedCrossRefGoogle Scholar
  25. 25.
    Cheng CL, Sherman S, Watkins JL, Barnett J, Freeman M, Geenen J, et al. Risk factors for post-ERCP pancreatitis: a prospective multicenter study. Am J Gastroenterol. 2006;101(1):139–47.PubMedCrossRefGoogle Scholar
  26. 26.
    Testoni PA, Mariani A, Giussani A, Vailati C, Masci E, Macarri G, et al. Risk factors for post-ERCP pancreatitis in high- and low-volume centers and among expert and non-expert operators: a prospective multicenter study. Am J Gastroenterol. 2010;105(8):1753–61.PubMedCrossRefGoogle Scholar
  27. 27.
    Vandervoort J, Soetikno RM, Tham TC, Wong RC, Ferrari Jr AP, Montes H, et al. Risk factors for complications after performance of ERCP. Gastrointest Endosc. 2002;56(5):652–6.PubMedCrossRefGoogle Scholar
  28. 28.
    Masci E, Mariani A, Curioni S, Testoni PA. Risk factors for pancreatitis following endoscopic retrograde cholangiopancreatography: a meta-analysis. Endoscopy. 2003;35(10):830–4.PubMedCrossRefGoogle Scholar
  29. 29.
    Cotton PB. ERCP is most dangerous for people who need it least. Gastrointest Endosc. 2001;54(4):535–6.PubMedCrossRefGoogle Scholar
  30. 30.
    Kapral C, Duller C, Wewalka F, Kerstan E, Vogel W, Schreiber F. Case volume and outcome of endoscopic retrograde cholangiopancreatography: results of a nationwide Austrian benchmarking project. Endoscopy. 2008;40(8):625–30.PubMedCrossRefGoogle Scholar
  31. 31.
    Williams EJ, Taylor S, Fairclough P, Hamlyn A, Logan RF, Martin D, et al. Risk factors for complication following ERCP; results of a large-scale, prospective multicenter study. Endoscopy. 2007;39(9):793–801.PubMedCrossRefGoogle Scholar
  32. 32.
    Swahn F, Nilsson M, Arnelo U, Lohr M, Persson G, Enochsson L. Rendezvous cannulation technique reduces post-ERCP pancreatitis: a prospective nationwide study of 12,718 ERCP procedures. Am J Gastroenterol. 2013;108(4):552–9.PubMedCrossRefGoogle Scholar
  33. 33.
    Colton JB, Curran CC. Quality indicators, including complications, of ERCP in a community setting: a prospective study. Gastrointest Endosc. 2009;70(3):457–67.PubMedCrossRefGoogle Scholar
  34. 34.
    Chutkan RK, Ahmad AS, Cohen J, Cruz-Correa MR, Desilets DJ, Dominitz JA, et al. ERCP core curriculum. Gastrointest Endosc. 2006;63(3):361–76.PubMedCrossRefGoogle Scholar
  35. 35.
    Lella F, Bagnolo F, Colombo E, Bonassi U. A simple way of avoiding post-ERCP pancreatitis. Gastrointest Endosc. 2004;59(7):830–4.PubMedCrossRefGoogle Scholar
  36. 36.
    Artifon EL, Sakai P, Cunha JE, Halwan B, Ishioka S, Kumar A. Guidewire cannulation reduces risk of post-ERCP pancreatitis and facilitates bile duct cannulation. Am J Gastroenterol. 2007;102(10):2147–53.PubMedCrossRefGoogle Scholar
  37. 37.
    Lee TH, Parkdo H, Park JY, Kim EO, Lee YS, Park JH, et al. Can wire-guided cannulation prevent post-ERCP pancreatitis? A prospective randomized trial. Gastrointest Endosc. 2009;69(3 Pt 1):444–9.PubMedCrossRefGoogle Scholar
  38. 38.
    Cote GA, Ansstas M, Pawa R, Edmundowicz SA, Jonnalagadda SS, Pleskow DK, et al. Difficult biliary cannulation: use of physician-controlled wire-guided cannulation over a pancreatic duct stent to reduce the rate of precut sphincterotomy (with video). Gastrointest Endosc. 2010;71(2):275–9.PubMedCrossRefGoogle Scholar
  39. 39.
    Cheung J, Tsoi KK, Quan WL, Lau JY, Sung JJ. Guidewire versus conventional contrast cannulation of the common bile duct for the prevention of post-ERCP pancreatitis: a systematic review and meta-analysis. Gastrointest Endosc. 2009;70(6):1211–9.PubMedCrossRefGoogle Scholar
  40. 40.
    Tse F, Yuan Y, Moayyedi P, Leontiadis GI. Guide wire-assisted cannulation for the prevention of post-ERCP pancreatitis: a systematic review and meta-analysis. Endoscopy. 2013;45(8):605–18.PubMedCrossRefGoogle Scholar
  41. 41.
    Bailey AA, Bourke MJ, Williams SJ, Walsh PR, Murray MA, Lee EY, et al. A prospective randomized trial of cannulation technique in ERCP: effects on technical success and post-ERCP pancreatitis. Endoscopy. 2008;40(4):296–301.PubMedCrossRefGoogle Scholar
  42. 42.
    Mariani A, Giussani A, Di Leo M, Testoni S, Testoni PA. Guidewire biliary cannulation does not reduce post-ERCP pancreatitis compared with the contrast injection technique in low-risk and high-risk patients. Gastrointest Endosc. 2012;75(2):339–46.PubMedCrossRefGoogle Scholar
  43. 43.
    Kobayashi G, Fujita N, Imaizumi K, Irisawa A, Suzuki M, Murakami A, et al. Wire-guided biliary cannulation technique does not reduce the risk of post-ERCP pancreatitis: multicenter randomized controlled trial. Dig Endosc. 2013;25(3):295–302.PubMedCrossRefGoogle Scholar
  44. 44.
    Tsujino T, Komatsu Y, Isayama H, Hirano K, Sasahira N, Yamamoto N, et al. Ulinastatin for pancreatitis after endoscopic retrograde cholangiopancreatography: a randomized, controlled trial. Clin Gastroenterol Hepatol. 2005;3(4):376–83.PubMedCrossRefGoogle Scholar
  45. 45.
    Cheon YK, Cho KB, Watkins JL, McHenry L, Fogel EL, Sherman S, et al. Frequency and severity of post-ERCP pancreatitis correlated with extent of pancreatic ductal opacification. Gastrointest Endosc. 2007;65(3):385–93.PubMedCrossRefGoogle Scholar
  46. 46.
    Wang P, Li ZS, Liu F, Ren X, Lu NH, Fan ZN, et al. Risk factors for ERCP-related complications: a prospective multicenter study. Am J Gastroenterol. 2009;104(1):31–40.PubMedCrossRefGoogle Scholar
  47. 47.
    Halttunen J, Meisner S, Aabakken L, Arnelo U, Gronroos J, Hauge T, et al. Difficult cannulation as defined by a prospective study of the Scandinavian Association for Digestive Endoscopy (SADE) in 907 ERCPs. Scand J Gastroenterol. 2014;49(6):752–8.PubMedCrossRefGoogle Scholar
  48. 48.
    Dumonceau JM, Deviere J, Cremer M. A new method of achieving deep cannulation of the common bile duct during endoscopic retrograde cholangiopancreatography. Endoscopy. 1998;30(7):S80.PubMedCrossRefGoogle Scholar
  49. 49.
    Maeda S, Hayashi H, Hosokawa O, Dohden K, Hattori M, Morita M, et al. Prospective randomized pilot trial of selective biliary cannulation using pancreatic guide-wire placement. Endoscopy. 2003;35(9):721–4.PubMedCrossRefGoogle Scholar
  50. 50.
    Herreros de Tejada A, Calleja JL, Diaz G, Pertejo V, Espinel J, Cacho G, et al. Double-guidewire technique for difficult bile duct cannulation: a multicenter randomized, controlled trial. Gastrointest Endosc. 2009;70(4):700–9.PubMedCrossRefGoogle Scholar
  51. 51.
    Ito K, Horaguchi J, Fujita N, Noda Y, Kobayashi G, Koshita S, et al. Clinical usefulness of double-guidewire technique for difficult biliary cannulation in endoscopic retrograde cholangiopancreatography. Dig Endosc. 2014;26(3):442–9.PubMedCrossRefGoogle Scholar
  52. 52.
    Ito K, Fujita N, Noda Y, Kobayashi G, Obana T, Horaguchi J, et al. Can pancreatic duct stenting prevent post-ERCP pancreatitis in patients who undergo pancreatic duct guidewire placement for achieving selective biliary cannulation? A prospective randomized controlled trial. J Gastroenterol. 2010;45(11):1183–91.PubMedCrossRefGoogle Scholar
  53. 53.
    Nakai Y, Isayama H, Sasahira N, Kogure H, Sasaki T, Yamamoto N, et al. Risk factors for post-ERCP pancreatitis in wire-guided cannulation for therapeutic biliary ERCP. Gastrointest Endosc. 2015;81(1):119–26.PubMedCrossRefGoogle Scholar
  54. 54.
    Williams EJ, Taylor S, Fairclough P, Hamlyn A, Logan RF, Martin D, et al. Are we meeting the standards set for endoscopy? Results of a large-scale prospective survey of endoscopic retrograde cholangio-pancreatograph practice. Gut. 2007;56(6):821–9.PubMedPubMedCentralCrossRefGoogle Scholar
  55. 55.
    Cennamo V, Fuccio L, Zagari RM, Eusebi LH, Ceroni L, Laterza L, et al. Can early precut implementation reduce endoscopic retrograde cholangiopancreatography-related complication risk? Meta-analysis of randomized controlled trials. Endoscopy. 2010;42(5):381–8.PubMedCrossRefGoogle Scholar
  56. 56.
    Bailey AA, Bourke MJ, Kaffes AJ, Byth K, Lee EY, Williams SJ. Needle-knife sphincterotomy: factors predicting its use and the relationship with post-ERCP pancreatitis (with video). Gastrointest Endosc. 2010;71(2):266–71.PubMedCrossRefGoogle Scholar
  57. 57.
    Choudhary A, Winn J, Siddique S, Arif M, Arif Z, Hammoud GM, et al. Effect of precut sphincterotomy on post-endoscopic retrograde cholangiopancreatography pancreatitis: a systematic review and meta-analysis. World J Gastroenterol. 2014;20(14):4093–101.PubMedPubMedCentralCrossRefGoogle Scholar
  58. 58.
    Katsinelos P, Gkagkalis S, Chatzimavroudis G, Beltsis A, Terzoudis S, Zavos C, et al. Comparison of three types of precut technique to achieve common bile duct cannulation: a retrospective analysis of 274 cases. Dig Dis Sci. 2012;57(12):3286–92.PubMedCrossRefGoogle Scholar
  59. 59.
    Yasuda I, Tomita E, Enya M, Kato T, Moriwaki H. Can endoscopic papillary balloon dilation really preserve sphincter of Oddi function? Gut. 2001;49(5):686–91.PubMedPubMedCentralCrossRefGoogle Scholar
  60. 60.
    Jang HW, Lee KJ, Jung MJ, Jung JW, Park JY, Park SW, et al. Endoscopic papillary large balloon dilatation alone is safe and effective for the treatment of difficult choledocholithiasis in cases of Billroth II gastrectomy: a single center experience. Dig Dis Sci. 2013;58(6):1737–43.PubMedCrossRefGoogle Scholar
  61. 61.
    Disario JA, Freeman ML, Bjorkman DJ, Macmathuna P, Petersen BT, Jaffe PE, et al. Endoscopic balloon dilation compared with sphincterotomy for extraction of bile duct stones. Gastroenterology. 2004;127(5):1291–9.PubMedCrossRefGoogle Scholar
  62. 62.
    Watanabe H, Yoneda M, Tominaga K, Monma T, Kanke K, Shimada T, et al. Comparison between endoscopic papillary balloon dilatation and endoscopic sphincterotomy for the treatment of common bile duct stones. J Gastroenterol. 2007;42(1):56–62.PubMedCrossRefGoogle Scholar
  63. 63.
    Baron TH, Harewood GC. Endoscopic balloon dilation of the biliary sphincter compared to endoscopic biliary sphincterotomy for removal of common bile duct stones during ERCP: a metaanalysis of randomized, controlled trials. Am J Gastroenterol. 2004;99(8):1455–60.PubMedCrossRefGoogle Scholar
  64. 64.
    Weinberg BM, Shindy W, Lo S. Endoscopic balloon sphincter dilation (sphincteroplasty) versus sphincterotomy for common bile duct stones. Cochrane Database Syst Rev. 2006;4, CD004890.PubMedGoogle Scholar
  65. 65.
    Liao WC, Tu YK, Wu MS, Wang HP, Lin JT, Leung JW, et al. Balloon dilation with adequate duration is safer than sphincterotomy for extracting bile duct stones: a systematic review and meta-analyses. Clin Gastroenterol Hepatol. 2012;10(10):1101–9.PubMedCrossRefGoogle Scholar
  66. 66.
    Feng Y, Zhu H, Chen X, Xu S, Cheng W, Ni J, et al. Comparison of endoscopic papillary large balloon dilation and endoscopic sphincterotomy for retrieval of choledocholithiasis: a meta-analysis of randomized controlled trials. J Gastroenterol. 2012;47(6):655–63.PubMedCrossRefGoogle Scholar
  67. 67.
    Madhoun MF, Wani S, Hong S, Tierney WM, Maple JT. Endoscopic papillary large balloon dilation reduces the need for mechanical lithotripsy in patients with large bile duct stones: a systematic review and meta-analysis. Diagn Ther Endosc. 2014;2014:309618.PubMedPubMedCentralCrossRefGoogle Scholar
  68. 68.
    Sherman S, Hawes RH, Troiano FP, Lehman GA. Pancreatitis following bile duct sphincter of Oddi manometry: utility of the aspirating catheter. Gastrointest Endosc. 1992;38(3):347–50.PubMedCrossRefGoogle Scholar
  69. 69.
    Kawakubo K, Isayama H, Nakai Y, Togawa O, Sasahira N, Kogure H, et al. Risk factors for pancreatitis following transpapillary self-expandable metal stent placement. Surg Endosc. 2011;26(3):771–6.PubMedCrossRefGoogle Scholar
  70. 70.
    Terruzzi V, Radaelli F, Meucci G, Minoli G. Is the supine position as safe and effective as the prone position for endoscopic retrograde cholangiopancreatography? A prospective randomized study. Endoscopy. 2005;37(12):1211–4.PubMedCrossRefGoogle Scholar
  71. 71.
    Tringali A, Mutignani M, Milano A, Perri V, Costamagna G. No difference between supine and prone position for ERCP in conscious sedated patients: a prospective randomized study. Endoscopy. 2008;40(2):93–7.PubMedCrossRefGoogle Scholar
  72. 72.
    Lee SJ, Lee TH, Park SH, Lee YN, Jung Y, Choi HJ, et al. Efficacy of carbon dioxide versus air insufflation according to different sedation protocols during therapeutic endoscopic retrograde cholangiopancreatography: prospective, randomized, double-blind study. Dig Endosc. 2015;27:512–21.PubMedCrossRefGoogle Scholar
  73. 73.
    Cheng Y, Xiong XZ, Wu SJ, Lu J, Lin YX, Cheng NS, et al. Carbon dioxide insufflation for endoscopic retrograde cholangiopancreatography: a meta-analysis and systematic review. World J Gastroenterol. 2012;18(39):5622–31.PubMedPubMedCentralCrossRefGoogle Scholar
  74. 74.
    Rey JF, Beilenhoff U, Neumann CS, Dumonceau JM. European Society of Gastrointestinal Endoscopy (ESGE) guideline: the use of electrosurgical units. Endoscopy. 2010;42(9):764–72.PubMedCrossRefGoogle Scholar
  75. 75.
    Verma D, Kapadia A, Adler DG. Pure versus mixed electrosurgical current for endoscopic biliary sphincterotomy: a meta-analysis of adverse outcomes. Gastrointest Endosc. 2007;66(2):283–90.PubMedCrossRefGoogle Scholar
  76. 76.
    Moon JH, Cho YD, Cha SW, Cheon YK, Ahn HC, Kim YS, et al. The detection of bile duct stones in suspected biliary pancreatitis: comparison of MRCP, ERCP, and intraductal US. Am J Gastroenterol. 2005;100(5):1051–7.PubMedCrossRefGoogle Scholar
  77. 77.
    Textor HJ, Flacke S, Pauleit D, Keller E, Neubrand M, Terjung B, et al. Three-dimensional magnetic resonance cholangiopancreatography with respiratory triggering in the diagnosis of primary sclerosing cholangitis: comparison with endoscopic retrograde cholangiography. Endoscopy. 2002;34(12):984–90.PubMedCrossRefGoogle Scholar
  78. 78.
    Ueno K, Ajiki T, Sawa H, Matsumoto I, Fukumoto T, Ku Y. Role of intraoperative cholangiography in patients whose biliary tree was evaluated preoperatively by magnetic resonance cholangiopancreatography. World J Surg. 2012;36(11):2661–5.PubMedCrossRefGoogle Scholar
  79. 79.
    Vazquez-Sequeiros E, Gonzalez-Panizo Tamargo F, Boixeda-Miquel D, Milicua JM. Diagnostic accuracy and therapeutic impact of endoscopic ultrasonography in patients with intermediate suspicion of choledocholithiasis and absence of findings in magnetic resonance cholangiography. Rev Esp Enferm Dig. 2011;103(9):464–71.PubMedCrossRefGoogle Scholar
  80. 80.
    van der Gaag NA, Rauws EA, van Eijck CH, Bruno MJ, van der Harst E, Kubben FJ, et al. Preoperative biliary drainage for cancer of the head of the pancreas. N Engl J Med. 2010;362(2):129–37.PubMedCrossRefGoogle Scholar
  81. 81.
    Cotton PB, Durkalski V, Romagnuolo J, Pauls Q, Fogel E, Tarnasky P, et al. Effect of endoscopic sphincterotomy for suspected sphincter of Oddi dysfunction on pain-related disability following cholecystectomy: the EPISOD randomized clinical trial. JAMA. 2014;311(20):2101–9.PubMedPubMedCentralCrossRefGoogle Scholar
  82. 82.
    Tenner S, Baillie J, DeWitt J, Vege SS. American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol. 2013;108(9):1400–15. 16.PubMedCrossRefGoogle Scholar
  83. 83.
    Mentula P, Leppaniemi A. Position paper: timely interventions in severe acute pancreatitis are crucial for survival. World J Emerg Surg. 2014;9(1):15.PubMedPubMedCentralCrossRefGoogle Scholar
  84. 84.
    Gardner TB, Vege SS, Pearson RK, Chari ST. Fluid resuscitation in acute pancreatitis. Clin Gastroenterol Hepatol. 2008;6(10):1070–6.PubMedCrossRefGoogle Scholar
  85. 85.
    Wu BU, Hwang JQ, Gardner TH, Repas K, Delee R, Yu S, et al. Lactated Ringer’s solution reduces systemic inflammation compared with saline in patients with acute pancreatitis. Clin Gastroenterol Hepatol. 2011;9(8):710–7.e1.PubMedCrossRefGoogle Scholar
  86. 86.
    Bhoomagoud M, Jung T, Atladottir J, Kolodecik TR, Shugrue C, Chaudhuri A, et al. Reducing extracellular pH sensitizes the acinar cell to secretagogue-induced pancreatitis responses in rats. Gastroenterology. 2009;137(3):1083–92.PubMedPubMedCentralCrossRefGoogle Scholar
  87. 87.
    Noble MD, Romac J, Vigna SR, Liddle RA. A pH-sensitive, neurogenic pathway mediates disease severity in a model of post-ERCP pancreatitis. Gut. 2008;57(11):1566–71.PubMedPubMedCentralCrossRefGoogle Scholar
  88. 88.
    Sagi SV, Schmidt S, Fogel E, Lehman GA, McHenry L, Sherman S, et al. Association of greater intravenous volume infusion with shorter hospitalization for patients with post-ERCP pancreatitis. J Gastroenterol Hepatol. 2014;29(6):1316–20.PubMedCrossRefGoogle Scholar
  89. 89.
    DiMagno MJ, Wamsteker EJ, Maratt J, Rivera MA, Spaete JP, Ballard DD, et al. Do larger periprocedural fluid volumes reduce the severity of post-endoscopic retrograde cholangiopancreatography pancreatitis? Pancreas. 2014;43(4):642–7.PubMedPubMedCentralCrossRefGoogle Scholar
  90. 90.
    Choudhary A, Bechtold ML, Arif M, Szary NM, Puli SR, Othman MO, et al. Pancreatic stents for prophylaxis against post-ERCP pancreatitis: a meta-analysis and systematic review. Gastrointest Endosc. 2011;73(2):275–82.PubMedCrossRefGoogle Scholar
  91. 91.
    Singh P, Das A, Isenberg G, Wong RC, Sivak Jr MV, Agrawal D, et al. Does prophylactic pancreatic stent placement reduce the risk of post-ERCP acute pancreatitis? A meta-analysis of controlled trials. Gastrointest Endosc. 2004;60(4):544–50.PubMedCrossRefGoogle Scholar
  92. 92.
    Mazaki T, Masuda H, Takayama T. Prophylactic pancreatic stent placement and post-ERCP pancreatitis: a systematic review and meta-analysis. Endoscopy. 2010;42(10):842–53.PubMedCrossRefGoogle Scholar
  93. 93.
    Mazaki T, Mado K, Masuda H, Shiono M. Prophylactic pancreatic stent placement and post-ERCP pancreatitis: an updated meta-analysis. J Gastroenterol. 2014;49(2):343–55.PubMedCrossRefGoogle Scholar
  94. 94.
    Fogel EL, Eversman D, Jamidar P, Sherman S, Lehman GA. Sphincter of Oddi dysfunction: pancreaticobiliary sphincterotomy with pancreatic stent placement has a lower rate of pancreatitis than biliary sphincterotomy alone. Endoscopy. 2002;34(4):280–5.PubMedCrossRefGoogle Scholar
  95. 95.
    Tarnasky PR. Mechanical prevention of post-ERCP pancreatitis by pancreatic stents: results, techniques, and indications. JOP. 2003;4(1):58–67.PubMedGoogle Scholar
  96. 96.
    Tarnasky PR, Palesch YY, Cunningham JT, Mauldin PD, Cotton PB, Hawes RH. Pancreatic stenting prevents pancreatitis after biliary sphincterotomy in patients with sphincter of Oddi dysfunction. Gastroenterology. 1998;115(6):1518–24.PubMedCrossRefGoogle Scholar
  97. 97.
    Sherman E, Bucksot B, Gottlieb L. Does leaving a main pancreatic duct stent in place reduce the incidence of precut biliary sphincterotomy (ES)-induced pancreatitis? A final analysis of a randomized prospective study. Gastrointest Endosc. 1996;43(4):413.Google Scholar
  98. 98.
    Harewood GC, Pochron NL, Gostout CJ. Prospective, randomized, controlled trial of prophylactic pancreatic stent placement for endoscopic snare excision of the duodenal ampulla. Gastrointest Endosc. 2005;62(3):367–70.PubMedCrossRefGoogle Scholar
  99. 99.
    Afghani E, Akshintala VS, Khashab MA, Law JK, Hutfless SM, Kim KJ, et al. 5-Fr vs. 3-Fr pancreatic stents for the prevention of post-ERCP pancreatitis in high-risk patients: a systematic review and network meta-analysis. Endoscopy. 2014;46(7):573–80.PubMedCrossRefGoogle Scholar
  100. 100.
    Freeman ML, Overby C, Qi D. Pancreatic stent insertion: consequences of failure and results of a modified technique to maximize success. Gastrointest Endosc. 2004;59(1):8–14.PubMedCrossRefGoogle Scholar
  101. 101.
    Bakman YG, Safdar K, Freeman ML. Significant clinical implications of prophylactic pancreatic stent placement in previously normal pancreatic ducts. Endoscopy. 2009;41(12):1095–8.PubMedCrossRefGoogle Scholar
  102. 102.
    Elmunzer BJ, Scheiman JM, Lehman GA, Chak A, Mosler P, Higgins PD, et al. A randomized trial of rectal indomethacin to prevent post-ERCP pancreatitis. N Engl J Med. 2012;366(15):1414–22.PubMedPubMedCentralCrossRefGoogle Scholar
  103. 103.
    Choksi NS, Fogel EL, Cote GA, Romagnuolo J, Elta GH, Scheiman JM, et al. The risk of post-ERCP pancreatitis and the protective effect of rectal indomethacin in cases of attempted but unsuccessful prophylactic pancreatic stent placement. Gastrointest Endosc. 2015;81(1):150–5.PubMedCrossRefGoogle Scholar
  104. 104.
    Ohuchida J, Chijiiwa K, Imamura N, Nagano M, Hiyoshi M. Randomized controlled trial for efficacy of nafamostat mesilate in preventing post-endoscopic retrograde cholangiopancreatography pancreatitis. Pancreas. 2015;44(3):415–21.PubMedGoogle Scholar
  105. 105.
    Park JY, Jeon TJ, Hwang MW, Sinn DH, Oh TH, Shin WC, et al. Comparison between ulinastatin and nafamostat for prevention of post-endoscopic retrograde cholangiopancreatography complications: a prospective, randomized trial. Pancreatology. 2014;14(4):263–7.PubMedCrossRefGoogle Scholar
  106. 106.
    Yuhara H, Ogawa M, Kawaguchi Y, Igarashi M, Shimosegawa T, Mine T. Pharmacologic prophylaxis of post-endoscopic retrograde cholangiopancreatography pancreatitis: protease inhibitors and NSAIDs in a meta-analysis. J Gastroenterol. 2014;49(3):388–99.PubMedCrossRefGoogle Scholar
  107. 107.
    Bai Y, Ren X, Zhang XF, Lv NH, Guo XG, Wan XJ, et al. Prophylactic somatostatin can reduce incidence of post-ERCP pancreatitis: multicenter randomized controlled trial. Endoscopy. 2015;45:415–20.Google Scholar
  108. 108.
    Omata F, Deshpande G, Tokuda Y, Takahashi O, Ohde S, Carr-Locke DL, et al. Meta-analysis: somatostatin or its long-acting analogue, octreotide, for prophylaxis against post-ERCP pancreatitis. J Gastroenterol. 2010;45(8):885–95.PubMedCrossRefGoogle Scholar
  109. 109.
    Shao LM, Chen QY, Chen MY, Cai JT. Nitroglycerin in the prevention of post-ERCP pancreatitis: a meta-analysis. Dig Dis Sci. 2010;55(1):1–7.PubMedCrossRefGoogle Scholar
  110. 110.
    Prat F, Amaris J, Ducot B, Bocquentin M, Fritsch J, Choury AD, et al. Nifedipine for prevention of post-ERCP pancreatitis: a prospective, double-blind randomized study. Gastrointest Endosc. 2002;56(2):202–8.PubMedCrossRefGoogle Scholar
  111. 111.
    Oh HC, Cheon YK, Cho YD, Do JH. Use of udenafil is not associated with a reduction in post-ERCP pancreatitis: results of a randomized, placebo-controlled, multicenter trial. Gastrointest Endosc. 2011;74(3):556–62.PubMedCrossRefGoogle Scholar
  112. 112.
    Nojgaard C, Hornum M, Elkjaer M, Hjalmarsson C, Heyries L, Hauge T, et al. Does glyceryl nitrate prevent post-ERCP pancreatitis? A prospective, randomized, double-blind, placebo-controlled multicenter trial. Gastrointest Endosc. 2009;69(6):e31–7.PubMedCrossRefGoogle Scholar
  113. 113.
    Bai Y, Gao J, Shi X, Zou D, Li Z. Prophylactic corticosteroids do not prevent post-ERCP pancreatitis: a meta-analysis of randomized controlled trials. Pancreatology. 2008;8(4–5):504–9.PubMedCrossRefGoogle Scholar
  114. 114.
    Bai Y, Gao J, Zhang W, Zou D, Li Z. Meta-analysis: allopurinol in the prevention of postendoscopic retrograde cholangiopancreatography pancreatitis. Aliment Pharmacol Ther. 2008;28(5):557–64.PubMedCrossRefGoogle Scholar
  115. 115.
    Cao WL, Yan WS, Xiang XH, Chen K, Xia SH. Prevention effect of allopurinol on post-endoscopic retrograde cholangiopancreatography pancreatitis: a meta-analysis of prospective randomized controlled trials. PLoS One. 2014;9(9):e107350.PubMedPubMedCentralCrossRefGoogle Scholar
  116. 116.
    Elmunzer BJ, Higgins PD, Saini SD, Scheiman JM, Parker RA, Chak A, et al. Does rectal indomethacin eliminate the need for prophylactic pancreatic stent placement in patients undergoing high-risk ERCP? Post hoc efficacy and cost-benefit analyses using prospective clinical trial data. Am J Gastroenterol. 2013;108(3):410–5.PubMedPubMedCentralCrossRefGoogle Scholar
  117. 117.
    Katsinelos P, Kountouras J, Paroutoglou G, Beltsis A, Mimidis K, Zavos C. Intravenous N-acetylcysteine does not prevent post-ERCP pancreatitis. Gastrointest Endosc. 2005;62(1):105–11.PubMedCrossRefGoogle Scholar
  118. 118.
    Li S, Cao G, Chen X, Wu T. Low-dose heparin in the prevention of post endoscopic retrograde cholangiopancreatography pancreatitis: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol. 2012;24(5):477–81.PubMedCrossRefGoogle Scholar
  119. 119.
    Lua GW, Muthukaruppan R, Menon J. Can rectal diclofenac prevent post endoscopic retrograde cholangiopancreatography pancreatitis? Dig Dis Sci. 2015;60(10):3118–23.PubMedCrossRefGoogle Scholar
  120. 120.
    Rabenstein T, Fischer B, Wiessner V, Schmidt H, Radespiel-Troger M, Hochberger J, et al. Low-molecular-weight heparin does not prevent acute post-ERCP pancreatitis. Gastrointest Endosc. 2004;59(6):606–13.PubMedCrossRefGoogle Scholar
  121. 121.
    Dai HF, Wang XW, Zhao K. Role of nonsteroidal anti-inflammatory drugs in the prevention of post-ERCP pancreatitis: a meta-analysis. Hepatobiliary Pancreat Dis Int. 2009;8(1):11–6.PubMedGoogle Scholar
  122. 122.
    Ding X, Chen M, Huang S, Zhang S, Zou X. Nonsteroidal anti-inflammatory drugs for prevention of post-ERCP pancreatitis: a meta-analysis. Gastrointest Endosc. 2012;76(6):1152–9.PubMedCrossRefGoogle Scholar
  123. 123.
    Elmunzer BJ, Waljee AK, Elta GH, Taylor JR, Fehmi SM, Higgins PD. A meta-analysis of rectal NSAIDs in the prevention of post-ERCP pancreatitis. Gut. 2008;57(9):1262–7.PubMedCrossRefGoogle Scholar
  124. 124.
    Kubiliun NM, Adams MA, Akshintala VS, Conte ML, Cote GA, Cotton PB, et al. Evaluation of pharmacologic prevention of pancreatitis after endoscopic retrograde cholangiopancreatography: a systematic review. Clin Gastroenterol Hepatol. 2015;13(7):1231–9.PubMedCrossRefGoogle Scholar
  125. 125.
    Li X, Tao LP, Wang CH. Effectiveness of nonsteroidal anti-inflammatory drugs in prevention of post-ERCP pancreatitis: a meta-analysis. World J Gastroenterol. 2014;20(34):12322–9.PubMedPubMedCentralCrossRefGoogle Scholar
  126. 126.
    Sethi S, Sethi N, Wadhwa V, Garud S, Brown A. A meta-analysis on the role of rectal diclofenac and indomethacin in the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis. Pancreas. 2014;43(2):190–7.PubMedCrossRefGoogle Scholar
  127. 127.
    Sun HL, Han B, Zhai HP, Cheng XH, Ma K. Rectal NSAIDs for the prevention of post-ERCP pancreatitis: a meta-analysis of randomized controlled trials. Surgeon. 2012;12(3):141–7.CrossRefGoogle Scholar
  128. 128.
    Yaghoobi M, Rolland S, Waschke KA, McNabb-Baltar J, Martel M, Bijarchi R, et al. Meta-analysis: rectal indomethacin for the prevention of post-ERCP pancreatitis. Aliment Pharmacol Ther. 2013;38(9):995–1001.PubMedCrossRefGoogle Scholar
  129. 129.
    Sotoudehmanesh R, Eloubeidi MA, Asgari AA, Farsinejad M, Khatibian M. A randomized trial of rectal indomethacin and sublingual nitrates to prevent post-ERCP pancreatitis. Am J Gastroenterol. 2014;109(6):903–9.PubMedCrossRefGoogle Scholar
  130. 130.
    Akbar A, Abu Dayyeh BK, Baron TH, Wang Z, Altayar O, Murad MH. Rectal nonsteroidal anti-inflammatory drugs are superior to pancreatic duct stents in preventing pancreatitis after endoscopic retrograde cholangiopancreatography: a network meta-analysis. Clin Gastroenterol Hepatol. 2013;11(7):778–83.PubMedCrossRefGoogle Scholar
  131. 131.
    Nicolas-Perez D, Castilla-Rodriguez I, Gimeno-Garcia AZ, Romero-Garcia R, Nunez-Diaz V, Quintero E. Prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: a cost-effectiveness analysis. Pancreas. 2015;44(2):204–10.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Center for Endoscopic Research and Therapeutics (CERT)University of Chicago MedicineChicagoUSA

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