Post-ERCP Pancreatitis: Review of Preventive Strategies
Post-ERCP Pancreatitis: Review of Preventive Strategies
Purpose of review This article reviews the most recent literature with significant findings pertaining to the prevention of postendoscopic retrograde cholangiopancreatography (ERCP) pancreatitis.
Recent findings Despite several promising reports of pharmacologic agents that have demonstrated the efficacy for prophylaxis against post-ERCP pancreatitis such as nonsteroidal anti-inflammatory drugs and secretin, there are currently no universally accepted agents for use in high-risk patients. The greatest reductions in the incidence of post-ERCP pancreatitis in high-risk patients have been demonstrated through advancements in endoscopic techniques such as pancreatic duct stenting and dye-free guidewire cannulation.
Summary Pancreatitis requiring hospitalization is the most common complication of ERCP. Numerous pharmaceutical and procedure related interventions have been studied in attempts to prevent this complication; however, morbidity associated with ERCP remains significant. The most effective methods for preventing post-ERCP pancreatitis are careful patient selection and identification of risk factors prior to procedure.
Endoscopic retrograde cholangiopancreatography (ERCP) is a widely used procedure to both diagnose and treat diseases of the pancreaticobiliary tree, with over 500 000 ERCP procedures performed annually in the USA alone. The most frequent and feared complication of ERCP is pancreatitis, which is associated with significant postprocedure morbidity and mortality. The incidence of post-ERCP pancreatitis (PEP) for both diagnostic and therapeutic ERCP is 0.4–1.5 and 1.6–5.4%, respectively, although some authors have cited rates of PEP up to 15% in high-risk patient subsets.
The prevention of PEP has been and remains an ongoing area of active research. There have been numerous proposed pharmacologic agents and therapeutic techniques aimed at reducing the risk of PEP. It has also been observed that certain patient populations are at significantly greater risk for PEP, and identification of patient and procedure related risk factors are important considerations in preventing or minimizing PEP.
This article will review the current research and state of the art regarding the prevention of PEP by pharmacologic, procedural, and patient selection perspectives.
Abstract and Introduction
Abstract
Purpose of review This article reviews the most recent literature with significant findings pertaining to the prevention of postendoscopic retrograde cholangiopancreatography (ERCP) pancreatitis.
Recent findings Despite several promising reports of pharmacologic agents that have demonstrated the efficacy for prophylaxis against post-ERCP pancreatitis such as nonsteroidal anti-inflammatory drugs and secretin, there are currently no universally accepted agents for use in high-risk patients. The greatest reductions in the incidence of post-ERCP pancreatitis in high-risk patients have been demonstrated through advancements in endoscopic techniques such as pancreatic duct stenting and dye-free guidewire cannulation.
Summary Pancreatitis requiring hospitalization is the most common complication of ERCP. Numerous pharmaceutical and procedure related interventions have been studied in attempts to prevent this complication; however, morbidity associated with ERCP remains significant. The most effective methods for preventing post-ERCP pancreatitis are careful patient selection and identification of risk factors prior to procedure.
Introduction
Endoscopic retrograde cholangiopancreatography (ERCP) is a widely used procedure to both diagnose and treat diseases of the pancreaticobiliary tree, with over 500 000 ERCP procedures performed annually in the USA alone. The most frequent and feared complication of ERCP is pancreatitis, which is associated with significant postprocedure morbidity and mortality. The incidence of post-ERCP pancreatitis (PEP) for both diagnostic and therapeutic ERCP is 0.4–1.5 and 1.6–5.4%, respectively, although some authors have cited rates of PEP up to 15% in high-risk patient subsets.
The prevention of PEP has been and remains an ongoing area of active research. There have been numerous proposed pharmacologic agents and therapeutic techniques aimed at reducing the risk of PEP. It has also been observed that certain patient populations are at significantly greater risk for PEP, and identification of patient and procedure related risk factors are important considerations in preventing or minimizing PEP.
This article will review the current research and state of the art regarding the prevention of PEP by pharmacologic, procedural, and patient selection perspectives.
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