Unresolved issues about post-ERCP pancreatitis: an overview

Pancreatitis represents the most common and feared complication after endoscopic retrograde cholangio-pancreatography. Since the introduction of ERCP into clinical practice, many attempts have been made to identify the mechanisms and conditions that can place patients at risk of developing post-procedure pancreatitis, with conflicting and in most cases unsatisfactory results. The following questions about post-ERCP pancreatitis still remain unanswered: the knowledge of the mechanisms involved in the onset of pancreatitis, procedural factors that can induce pancreatic damage, patient conditions that can increase the risk of developing pancreatitis in the post-procedure period, criteria for predicting the occurrence of pancreatitis, and possible methods of preventing the complication. Moreover, the criteria used to define post-ERCP pancreatitis differ in various studies and, consequently, there is a wide variation in the literature of the incidence of this complication and it is still not clear what its real incidence is. In the last six years, a significant advance in knowledge has been achieved in most of the above-mentioned fields. Four large prospective multicentre trials seemed to definitely identify patient- and technique-related risk factors that can place patients at risk of developing post-ERCP pancreatitis; clinical conditions, procedure- and patient-related factors, and laboratory tests able to predict the occurrence of post-ERCP pancreatitis in the early phase have been identified. An attempt to identify criteria for defining post-ERCP pancreatitis has also been carried out, although these proposed criteria have not been widely adopted by all Authors.