Prevention of post-ERCP pancreatitis

Over the last 10-15 years there have been refinements in the understanding of risk factors for development of acute post-ERCP pancreatitis (PEP). These risk factors can be divided into patient risks and procedural risks. The most basic way to prevent PEP is avoidance of purely diagnostic ERCP and low-probability ERCP for bile duct stones by use of non-invasive or less-invasive imaging procedures. Improvement in cannulation techniques has led to a reduction in PEP. Placement of prophylactic pancreatic stents and, more recently, use of rectally administered non-steroidal anti-inflammatory agents (NSAIDs) has further reduced the risk of PEP in high-risk patients and/or following high-risk procedures. In this review the methods for prevention of PEP will be discussed.