title: Preventing post-endoscopic retrograde cholangiopancreatography pancreatitis: what can be done?
abstract: Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is the most common complication of endoscopic retrograde cholangiopancreatography. The incidence of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis varies substantially and is reported around 1%-10%, although there are some reports with an incidence of around 30%. Usually, PEP is a mild or moderate pancreatitis, but in some instances it can be severe and fatal. Generally, it is defined as the onset of new pancreatic-type abdominal pain severe enough to require hospital admission or prolonged hospital stay with levels of serum amylase two to three times greater than normal, occurring 24 h after ERCP. Several methods have been adopted for preventing pancreatitis, such as pharmacological or endoscopic approaches. Regarding medical prevention, only non-steroidal anti-inflammatory drugs, namely diclofenac sodium and indomethacin, are recommended, but there are some other drugs which have some potential benefits in reducing the incidence of post-ERCP pancreatitis. Endoscopic preventive measures include cannulation (wire guided) and pancreatic stenting, while the adoption of the early pre-cut technique is still arguable. This review will attempt to present and discuss different ways of preventing post-ERCP pancreatitis.
authors: Goran Hauser, Davor Stimac, Department of Internal Medicine, Division of Gastroenterology, Clinical Hospital Centre Rijeka, 51000 Rijeka, Croatia.
authors: Goran
authors: G
authors: Hauser
authors: Goran Hauser, Davor Stimac, Department of Internal Medicine, Division of Gastroenterology, Clinical Hospital Centre Rijeka, 51000 Rijeka, Croatia.
authors: Marko
authors: M
authors: Milosevic
authors: Goran Hauser, Davor Stimac, Department of Internal Medicine, Division of Gastroenterology, Clinical Hospital Centre Rijeka, 51000 Rijeka, Croatia.
authors: Davor
authors: D
authors: Stimac
authors: Goran Hauser, Davor Stimac, Department of Internal Medicine, Division of Gastroenterology, Clinical Hospital Centre Rijeka, 51000 Rijeka, Croatia.
authors: Enver
authors: E
authors: Zerem
authors: Goran Hauser, Davor Stimac, Department of Internal Medicine, Division of Gastroenterology, Clinical Hospital Centre Rijeka, 51000 Rijeka, Croatia.
authors: Predrag
authors: P
authors: Jovanović
authors: Goran Hauser, Davor Stimac, Department of Internal Medicine, Division of Gastroenterology, Clinical Hospital Centre Rijeka, 51000 Rijeka, Croatia.
authors: Ivana
authors: I
authors: Blazevic
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects* / Q000295:instrumentation*; D006801:Humans; D010195:Pancreatitis / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents
keywords: Endoscopic retrograde cholangiopancreatography; Post-endoscopic retrograde cholangiopancreatography pancreatitis; Sphincterotomy
references: Gut. 2008 Sep;57(9):1262-7
references: 18375470
references: World J Gastrointest Endosc. 2014 May 16;6(5):200-8
references: 24891933
references: Gastrointest Endosc. 2006 Sep;64(3):351-7
references: 16923481
references: PLoS One. 2013;8(10):e75645
references: 24098392
references: World J Gastrointest Endosc. 2012 Jun 16;4(6):241-6
references: 22720126
references: Gastroenterology. 2014 Jan;146(1):313-5; discussion 315
references: 24269561
references: Gastrointest Endosc. 2009 Jul;70(1):80-8
references: 19286178
references: Am J Gastroenterol. 2009 Sep;104(9):2343-50
references: 19532133
references: N Engl J Med. 1996 Sep 26;335(13):919-23
references: 8786777
references: Gastrointest Endosc. 2011 Feb;73(2):275-82
references: 21295641
references: Endoscopy. 2002 Apr;34(4):280-5
references: 11932782
references: World J Gastroenterol. 2014 Apr 14;20(14):4093-101
references: 24744601
references: Endoscopy. 2010 Oct;42(10):842-53
references: 20886403
references: Cochrane Database Syst Rev. 2010;(10):CD007345
references: 20927758
references: Gastrointest Endosc. 2010 May;71(6):934-9, 939.e1-2
references: 20226455
references: Endoscopy. 2010 May;42(5):381-8
references: 20306386
references: Am J Gastroenterol. 2007 May;102(5):978-83
references: 17355281
references: Endoscopy. 2012 Jan;44(1):53-9
references: 22198776
references: Endoscopy. 2009 Aug;41(8):690-5
references: 19670137
references: Gastrointest Endosc. 2001 Oct;54(4):425-34
references: 11577302
references: Dig Endosc. 2009 Jan;21(1):8-13
references: 19691794
references: Endoscopy. 1994 Nov;26(9):715-8
references: 7536155
references: Digestion. 2007;75(2-3):156-63
references: 17684365
references: J Gastrointestin Liver Dis. 2009 Mar;18(1):73-82
references: 19337638
references: Endoscopy. 2010 Jun;42(6):503-15
references: 20506068
references: J Gastrointest Surg. 2001 Jul-Aug;5(4):339-45; discussion 345
references: 11985972
references: Gastrointest Endosc. 2002 Apr;55(4):476-83
references: 11923757
references: BMC Gastroenterol. 2013;13:11
references: 23320650
references: Hepatogastroenterology. 2011 Jan-Feb;58(105):168-73
references: 21510308
references: J Gastroenterol. 2014 Mar;49(3):388-99
references: 23720090
references: Clin Gastroenterol Hepatol. 2004 Apr;2(4):322-9
references: 15067627
references: Gastrointest Endosc. 2005 Mar;61(3):407-15
references: 15758912
references: Pancreas. 2009 Mar;38(2):126-30
references: 19238021
references: Endoscopy. 2014 Jul;46(7):573-80
references: 24830399
references: Surg Endosc. 2010 Nov;24(11):2670-80
references: 20414680
references: J Hepatobiliary Pancreat Sci. 2010 Jan;17(1):70-8
references: 20012323
references: Clin Gastroenterol Hepatol. 2009 Aug;7(8):834-9
references: 19447196
references: Gastroenterol Res Pract. 2012;2012:796751
references: 21845187
references: Gut. 1985 Feb;26(2):194-7
references: 3917965
references: Gastrointest Endosc. 2007 Dec;66(6):1126-32
references: 18061712
references: Endoscopy. 2011 Apr;43(4):325-30
references: 21455872
references: Eur J Surg. 1997 Dec;163(12):915-22
references: 9449444
references: Hepatogastroenterology. 1993 Dec;40(6):522-30
references: 7509768
references: J Gastroenterol Hepatol. 2008 Jul;23(7 Pt 2):e11-6
references: 17683501
references: N Engl J Med. 2012 Apr 12;366(15):1414-22
references: 22494121
references: Gastrointest Endosc. 2004 Jun;59(7):845-64
references: 15173799
references: J Gastrointest Surg. 2003 Dec;7(8):940-2
references: 14675701
references: Am J Gastroenterol. 2003 Oct;98(10):2182-6
references: 14572565
references: Gastrointest Endosc. 1991 May-Jun;37(3):383-93
references: 2070995
references: Clin Gastroenterol Hepatol. 2014 Feb;12(2):303-7.e1
references: 23920031
references: Gastrointest Endosc. 2004 Oct;60(4):544-50
references: 15472676
references: Gastrointest Endosc. 2005 Aug;62(2):245-50
references: 16046988
references: Rev Esp Enferm Dig. 2007 Jun;99(6):330-6
references: 17883296
references: Endoscopy. 2001 Apr;33(4):323-8
references: 11315893
references: Gastroenterology. 2014 Feb;146(2):581-2
references: 24355613
references: Intern Med. 2011;50(24):2927-32
references: 22185981
references: Eur J Gastroenterol Hepatol. 2012 May;24(5):477-81
references: 22293331
references: BMC Gastroenterol. 2010;10:85
references: 20673365
references: World J Gastroenterol. 2009 Apr 7;15(13):1600-6
references: 19340902
references: Gastroenterology. 2003 Jun;124(7):1786-91
references: 12806612
references: Am J Gastroenterol. 2014 Jun;109(6):903-9
references: 24513806