ERCP-induced Pancreatitis.
The most important consideration in preventing ERCP-induced pancreatitis is patient selection. If you want to avoid pancreatitis, avoid performing ERCP in young patients for sphincter of Oddi dysfunction. Sphincter of Oddi manometry, difficult biliary cannulations (repeated pancreatic duct cannulations/injections), and precut and pancreatic sphincterotomy are associated with increased risk of pancreatitis. Pancreatic endotherapy, precut sphincterotomy, and Sphincter of Oddi manometry should be reserved for expert endoscopists. Short-term pancreatic stenting appears to decrease the risk of pancreatitis in patients undergoing these higher-risk procedures. Chemoprevention for ERCP-induced pancreatitis appears promising, but needs further critical study with larger patient populations and agents amenable to outpatient use. Fortunately, most ERCP-induced pancreatitis is mild. More severe pancreatitis requires a team approach to management with surgery, radiology, gastroenterology, and other specialists (eg, nephrologist) as indicated participating in the patient's care.
Branch
S
Gastroenterology Division, Duke University Medical Center, PO Box 3662, Durham, NC 27710, USA. branc003@mc.duke.edu