A Review of Prevention of Post-ERCP Pancreatitis
#MMPMID29991936
Morales SJ
; Sampath K
; Gardner TB
Gastroenterol Hepatol (N Y)
2018[May]; 14
(5
): 286-292
PMID29991936
show ga
Endoscopic retrograde cholangiopancreatography (ERCP) is a diagnostic and
therapeutic procedure employed in the management of disorders of the biliary
system. Post-ERCP pancreatitis (PEP) is the most common complication of ERCP and
can lead to significant morbidity as well as occasional mortality. In addition to
adequate procedural training, therapeutic endoscopists who perform ERCPs should
possess a thorough understanding of patient- and procedure-related risk factors
for PEP. This knowledge can inform patient selection for ERCP and allow for
appropriate management efforts to be performed in high-risk cases. Procedural
techniques promoting minimally traumatic biliary cannulation should be employed
when initial standard techniques are unsuccessful. In high-risk patients, several
measures can be undertaken to limit the risk of PEP, including administration of
rectal nonsteroidal anti-inflammatory drugs, prophylactic placement of pancreatic
duct stents, and liberal administration of lactated Ringer solution. When PEP
does occur, appropriate management with aggressive intravenous hydration, pain
control, and early enteral nutrition should be administered. Additional research
is needed to further define risk factors for PEP, optimal procedural techniques
used during ERCP, and ideal prevention and treatment strategies to limit the
incidence and severity of PEP in patients.
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