Post-ERCP pancreatitis. A single center experience and an update on prevention strategies

Pancreatitis is the most frequent complication of the ERCP; in unselected patients the incidence is 3.5%, reaching 25%, and is mild-moderate in 90%. A stratification of patients into low or high risk is important to provide adequate information to patients and to decide when refer them to tertiary centers; moreover, many prophylactic measures have been proposed over years. Our aim was to select risk factors for PEP and compare them with current literature in order to propose adequate preventive strategies.

It was analyzed the occurrence of Post-ERCP Pancreatitis in a series of 492 consecutives patients treated with ERCP by two expert interventional endoscopists. The possible risk factors were evidenced by a multivariate analysis, were states our proposals for Post-ERCP Pancreatitis prevention and compared them to the current literature.

We observed 14 PEP (2.8%), 6 mild, 4 moderates and 4 severe. The multivariate analysis evidenced as risk factors the high number of attempts of cannulation and the pancreatic injection of contrast medium and found a protective role for pre-cut sphincterotomy. Our mortality rate was 0.4%.

The guide-wire cannulation technique and, in selected cases, the pre-cut permit to minimize the number of cannulation attempts and to increase the success rate of primary cannulation; we promote their use to reduce PEP occurrence.