Abstract
Background
Endoscopic retrograde cholangiopancreatography (ERPC) is used for the diagnosis and treatment of pancreatic and biliary diseases. Post-ERCP pancreatitis (PEP) is a complication which needs special care and clinical practice guideline for this morbidity is also needed.
Methods
The key clinical issues of diagnosis and treatment of PEP were listed and checked, and then the clinical questions were formulated. PubMed (MEDLINE) and Ichushi-web (Japanese medical literature) were used as databases. For the study of diagnostic test accuracy, items similar to QUADAS-2, i.e., random selection from a population to which the diagnostic test is applied, blinding of index tests and reference tests, completeness of reference standard, completeness of test implementations, the same timing of tests, and missing data were assessed as well as the indirectness of the study subjects, index tests, reference standard, and outcomes. Grading of recommendations was determined as strong or weak. In clinical practice, the judgment of attending doctors should be more important than recommendations described in clinical practice guidelines. Gastroenterologists are the target users of this clinical practice guideline. General practitioners or general citizens are not supposed to use this guideline. The guideline committee has decided to include wide clinical issues such as etiological information, techniques of ERCP, the diagnosis, treatments, and monitoring of PEP in this guideline.
Results
In this concise report, we described ten clinical questions, recommendations, and explanations pertaining to risk factors, diagnosis, prognostic factors, treatments, and preventive interventions in the medical practice for PEP.
Conclusions
We reported here the essence of the clinical practice guideline for PEP.
Similar content being viewed by others
References
IOM (Institute of Medicine). Finding What Works in Health Care: Standards for Systematic Reviews. Washington, DC: The National Academies Press. 2011. (http://www.iom.edu/Reports/2011/Finding-What-Works-in-Health-Care-Standards-for-Systematic-Reviews/Standards.aspx).
Graham R, Mancher M, Wolman DM, et al. Committee on Standards for Developing Trustworthy Clinical Practice Guidelines; Institute of Medicine: Clinical Practice Guidelines We Can Trust. (http://www.nap.edu/catalog/13058/clinical-practice-guidelines-we-can-trust).
Schünemann H, Brożek J, Guyatt G, et al. GRADE handbook for grading quality of evidence and strength of recommendations. Updated October 2013. The GRADE Working Group, 2013. (www.guidelinedevelopment.org/handbook).
Minds Guideline Center, Japan Council for Quality Health Care. Minds handbook for clinical practice guideline development 2014. 2014.
Whiting PF, Rutjes AW, Westwood ME, et al. QUADAS-2 Group: QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011;155:529–36.
Villatoro E, Bassi C, Larvin M. Antibiotics therapy for prophylaxis against infection of pancreatic necrosis in acute pancreatitis. Cochrane Database Syst Rev. 2006;4:CD002941.
Working UK. Party on acute pancreatitis: UK guidelines for management of acute pancreatitis. Gut. 2005;54(Suppl 3):31–9.
Forsmark CE, Baillie J. AGA Institute Clinical Practice and Economics Committee, AGA Institute Governing Board, AGA Institute technical review on acute pancreatitis. Gastroenterology. 2007;132:2022–44.
Golub R, Siddiqi F, Pohl D. Role of antibiotics in acute pancreatitis: a meta-analysis. J Gastrointest Surg. 1998;2:496–503.
Sharma VK, Howden CW. Prophylactic antibiotics administration reduces sepsis and mortality in acute necrotizing pancreatitis: a meta-analysis. Pancreas. 2001;22:28–31.
de Vries AC, Besselink MGH, Buskens E, et al. Randomized controlled trials of antibiotic prophylaxis in severe acute pancreatitis: relationship between methodological quality and outcome. Pancreatology. 2007;7:531–8.
Bai Y, Gao J, Zou D, et al. Prophylactic antibiotics cannot reduce infected pancreatic necrosis and mortality in acute necrotizing pancreatitis: evidence from meta-analysis of randomized controlled trials. Am J Gastroenterol. 2008;103:104–10.
Akshintala VS, Hutfless SM, Colantuoni E, et al. Systematic review with network meta-analysis: pharmacological prophylaxis against post-ERCP pancreatitis. Aliment Pharmacol Ther. 2013;38:1325–37.
Pederzoli P, Bassi C, Vesentini S, et al. A randomized multicenter clinical trial of antibiotics prophylaxis of septic complications in acute necrotizing pancreatitis with imipenem. Surg Gynecol Obstet. 1993;176:480–3.
Schwarz M, Isenmann R, Meyer H, et al. Antibiotic use in necrotizing pancreatitis. Results of controlled study. Dtsch Med Wochenschr. 1997;122:356–61.
Nordback I, Sand J, Saaristo R, et al. Early treatment with antibiotics reduces the need for surgery in acute necrotizing pancreatitis—a single-center randomized study. J Gastrointest Surg. 2001;5:113–8.
Manes G, Rabitti PG, Menchise A, et al. Prophylaxis with meropenem of septic complications in acute pancreatitis: a randomized, controlled trial versus imipenem. Pancreas. 2003;27:e79–83.
Manes G, Uomo I, Menchise A, et al. Timing of antibiotics prophylaxis in acute pancreatitis: a controlled randomized study with meropenem. Am J Gastroenterol. 2006;101:1348–53.
Isennman R, Runzi M, Kroon M, et al. Prophylactic antibiotic treatment in patients with predicted severe acute pancreatitis: a placebo-controlled, double-blind trial. Gastroenterology. 2004;126:997–1004.
Grag PK, Khanna S, Bohidar NP, et al. Incidence, spectrum and antibiotic sensitivity pattern of bacterial infections among patients with acute pancreatitis. J Gastroenterol Hepatol. 2001;16:1055–9.
Kadokawa Y, Takeda K, Sunamura M, et al. Effectiveness of continuous arterial infusion of protease inhibitors for experimental acute pancreatitis caused by the creation of a blind duodenal loop. J Jpn Soc Gastroenterol. 1990;87:1444–50.
Hayashi J, Kawarada Y, Isaji S, et al. Therapeutic effects of continuous itraarterial antibiotics infusion in preventing pancreatic infection in experimental acute necrotizing pancreatitis. Pancreas. 1996;13:184–92.
Mikami Y, Takeda K, Matsuda K, et al. Rat experimental model of regional arterial infusion of protease inhibitor and its effects on severe acute pancreatitis. Pancreas. 2005;30:248–53.
Takeda K, Matsuno S, Sunamura M, et al. Continuous regional arterial infusion of protease inhibitor and antibiotics in acute necrotizing pancreatitis. Am J Surg. 1996;171:394–8 (level 3b).
Takeda K, Yamauchi J, Shibuya K, et al. Benefit of continuous regional arterial infusion of protease inhibitor and antibiotics in the management of acute necrotizing pancreatitis. Pancreatology. 2001;1:668–73 (level 3b).
Consensus Revision Committee on Early Diagnosis and Treatment of Acute Pancreatitis. Revised guidelines for the early diagnosis and treatment of acute pancreatitis by the Consensus Revision Committee, third edition. Pancreas. 2011;26:651–83.
Mine T, Akashi R, Igarashi Y, et al. Ministry of Health, Labour and Welfare Grant-in-Aid for Scientific Research. Research on measures for intractable disease. Survey on Intractable Diseases. 2008 Technical report on survey of intractable pancreatic disease 2009; 77–78.
Seta T, Noguchi Y. Protease inhibitors for preventing complications associated with ERCP: an updated meta-analysis. Gastrointest Endosc. 2011;73(4):700–706.e1-2.
Andriulli A, Clemente R, Solmi L, et al. Gabexate or somatostatin administration before ERCP in patients at high risk for post-ERCP pancreatitis: a multicenter, placebo-controlled, randomized clinical trial. Gastrointest Endosc. 2002;56:488–95.
Andriulli A, Solmi L, Loperfido S, et al. Prophylaxis of ERCP-related pancreatitis: a randomized, controlled trial of somatostatin and gabexate mesylate. Clin Gastroenterol Hepatol. 2004;2:713–8.
Benvenutti S, Zancanella L, Piazzi L, et al. Prevention of post-ERCP pancreatitis with somatostatin versus gabexate mesylate: a randomized placebo controlled multicenter study. Dig Liv Dis. 2006;38:S15.
Cavallini G, Tittobello A, Frulloni L, et al. Gabexate for the prevention of pancreatic damage related to endoscopic retrograde cholangiopancreatography. Gabexate in digestive endoscopy—Italian Group. N Engl J Med. 1996;335:919–23.
Manes G, Ardizzone S, Lombardi G, et al. Efficacy of postprocedure administration of gabexate mesylate in the prevention of post-ERCP pancreatitis: a randomized, controlled, multicenter study. Gastrointest Endosc. 2007;65:982–7.
Xiong GS, Wu SM, Zhang XW, et al. Clinical trial of gabexate in the prophylaxis of post-endoscopic retrograde cholangiopancreatography pancreatitis. Braz J Med Biol Res. 2006;39:85–90.
Zheng M, Chen Y, Yang X, et al. Gabexate in the prophylaxis of post-ERCP pancreatitis: a meta-analysis of randomized controlled trials. BMC Gastroenterol. 2007;7:6–13.
Andriulli A, Leandro G, Federici T, et al. Prophylactic administration of somatostatin or gabexate does not prevent pancreatitis after ERCP: an updated meta-analysis. Gastrointest Endosc. 2007;65:624–32.
Rudin D, Kiss A, Wetz RV, et al. Somatostatin and gabexate for post-endoscopic retrograde cholangiopancreatography pancreatitis prevention: meta-analysis of randomized placebo-controlled trials. J Gastroenterol Hepatol. 2007;22:977–83.
Tsujino T, Komatsu Y, Isayama H, et al. Ulinastatin for pancreatitis after endoscopic retrograde cholangiopancreatography: a randomized, controlled trial. Clin Gastroenterol Hepatol. 2005;3:376–83.
Ueki T, Otani K, Kawamoto K, et al. Comparison between ulinastatin and gabexate mesylate for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: a prospective, randomized trial. J Gastroenterol. 2007;42:161–7.
Yoo JW, Ryu JK, Lee SH, et al. Preventive effects of ulinastatin on post-endoscopic retrograde cholangiopancreatography pancreatitis in high-risk patients: a prospective, randomized, placebo-controlled trial. Pancreas. 2008;37:366–70.
Dai HF, Wang XW, Zhao K. Role of nonsteroidal anti-inflammatory drugs in the prevention of post-ERCP pancreatitis: a meta-analysis. Hepat Pancreat Dis Int. 2009;8:11–6.
Elmunzer B, Waljee A, Elta G, et al. A meta-analysis of rectal NSAIDs in the prevention of post-ERCP pancreatitis. Gut. 2008;57:1262.
Zheng M-H, Xia H, Chen Y-P. Rectal administration of NSAIDs in the prevention of post-ERCP pancreatitis: a complementary meta-analysis. Gut. 2008;57:1632.
Akshintala VS, Hutfless SM, Colantuoni E, et al. Systematic review with network meta-analysis: pharmacological prophylaxis against post-ERCP pancreatitis. Aliment Pharmacol Ther. 2013;38(11–12):1325–37.
Otsuka T, Kawazoe S, Nakashita S, et al. Low-dose rectal diclofenac for prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: a randomized controlled trial. J Gastroenterol. 2012;47(8):912–7.
Singh P, Das A, Isenberg G, 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.
Andriulli A, Forlano R, Napolitano G, et al. Pancreatic duct stents in the prophylaxis of pancreatic damage after endoscopic retrograde cholangiopancreatography: a systematic analysis of benefits and associated risks. Digestion. 2007;75(2–3):156–63.
Choudhary A, Bechtold ML, Arif M, et al. Pancreatic stents for prophylaxis against post-ERCP pancreatitis: a meta-analysis and systematic review. Gastrointest Endosc. 2011;73(2):275–82.
Sofuni A, Maguchi H, Itoi T, et al. Prophylaxis of post-endoscopic retrograde cholangiopancreatography pancreatitis by an endoscopic pancreatic spontaneous dislodgement stent. Clin Gastroenterol Hepatol. 2007;5:1339–46.
Chahal P, Tarnasky PR, Petersen BT, et al. Short 5Fr vs long 3Fr pancreatic stents in patients at risk for post-endoscopic retrograde cholangiopancreatography pancreatitis. Clin Gastroenterol Hepatol. 2009;7(8):834–9.
Fehmi SMA, Schoenfeld PS, Scheiman JM, et al. 5 Fr prophylactic pancreatic stents are easier to place and require fewer guide wires than 3 Fr stents. Gastrointest Endosc. 2008;67:AB328–9.
Smith MT, Sherman S, Ikenberry SO, et al. Alterations in pancreatic ductal morphology following polyethylene pancreatic stent therapy. Gastrointest Endosc. 1996;44:268–75.
Bailey AA, Bourke MJ, Williams SJ, et al. A prospective randomized trial of cannulation technique in ERCP: effects on technical success and post-ERCP pancreatitis. Endoscopy. 2008;40:296–301.
Katsinelos P, Paroutoglou G, Kountouras J, et al. A comparative study of standard ERCP catheter and hydrophilic guide wire in the selective cannulation of the common bile duct. Endoscopy. 2008;40:302–7.
Kawakami H, Maguchi H, Mukai T, et al. A multicenter, prospective, randomized study of selective bile duct cannulation performed by multiple endoscopists: the BIDMEN study. Gastrointest Endosc. 2012;75:362–72.
Kobayashi G, Fujita N, Imaizumi K, et al. Wire-guided biliary cannulation technique does not reduce the risk of post-ERCP pancreatitis: multicenter randomized controlled trial. Dig Endosc. 2013;25:295–302.
Cheung J, Tsoi KK, Quan W-L, et al. 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;70:1211–9.
Tse F, Yuan Y, Moayyedi P, et al. Guidewire-assisted cannulation of the common bile duct for the prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. Cochrane Database Syst Rev. 2012;12:CD009662.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
Mine, T., Morizane, T., Kawaguchi, Y. et al. Clinical practice guideline for post-ERCP pancreatitis. J Gastroenterol 52, 1013–1022 (2017). https://doi.org/10.1007/s00535-017-1359-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00535-017-1359-5