A Review of Prevention of Post-ERCP Pancreatitis

Endoscopic retrograde cholangiopancreatography (ERCP) is a diagnostic and therapeutic procedure employed in the management of disorders of the biliary system. Post-ERCP pancreatitis (PEP) is the most common complication of ERCP and can lead to significant morbidity as well as occasional mortality. In addition to adequate procedural training, therapeutic endoscopists who perform ERCPs should possess a thorough understanding of patient- and procedure-related risk factors for PEP. This knowledge can inform patient selection for ERCP and allow for appropriate management efforts to be performed in high-risk cases. Procedural techniques promoting minimally traumatic biliary cannulation should be employed when initial standard techniques are unsuccessful. In high-risk patients, several measures can be undertaken to limit the risk of PEP, including administration of rectal nonsteroidal anti-inflammatory drugs, prophylactic placement of pancreatic duct stents, and liberal administration of lactated Ringer solution. When PEP does occur, appropriate management with aggressive intravenous hydration, pain control, and early enteral nutrition should be administered. Additional research is needed to further define risk factors for PEP, optimal procedural techniques used during ERCP, and ideal prevention and treatment strategies to limit the incidence and severity of PEP in patients.