How to prevent post-ERCP pancreatitis?

Area of Science:

• Gastroenterology and Endoscopy
• Pancreatic Diseases
• Medical Interventions

Background:

• Post-ERCP pancreatitis (PEP) incidence has remained stable for three decades.
• Significant advancements in understanding PEP predisposing factors and effective prevention measures have occurred in the last decade.
• Widespread implementation of established PEP prophylaxis measures remains limited.

Purpose of the Study:

• To review and summarize current recommendations for preventing post-ERCP pancreatitis (PEP).
• To highlight effective strategies for both high-risk and low-risk endoscopic retrograde cholangiopancreatography (ERCP) procedures.
• To identify areas for further investigation in PEP prophylaxis, particularly concerning pancreatic stenting.

Main Methods:

• Review of current literature and clinical knowledge on PEP.
• Summarization of established and emerging prophylactic measures for PEP.
• Categorization of ERCP procedures into high-risk and low-risk based on PEP likelihood.

Main Results:

• Prophylactic pancreatic stent placement is recommended for high-risk ERCPs (e.g., ampullectomy, pancreatic sphincterotomy, precut biliary sphincterotomy, suspected sphincter of Oddi dysfunction, guidewire-assisted biliary cannulation, endoscopic balloon sphincteroplasty).
• Periprocedure rectal administration of non-steroidal anti-inflammatory drugs (NSAIDs) is recommended for low-risk ERCPs.
• Further investigation into prophylactic pancreatic stenting is needed, focusing on endoscopist training, ease of insertion, spontaneous stent elimination, and safety.

Conclusions:

• Evidence-based guidelines for PEP prophylaxis exist and should be implemented more widely.
• Tailored strategies, including pancreatic stenting and NSAIDs, are effective for preventing PEP in different risk categories.
• Continued research and education are crucial for optimizing pancreatic stent use and improving overall PEP prevention.