Clinical Practice Guidelines for post-ERCP pancreatitis 2023

Area of Science:

• Gastroenterology
• Clinical Practice Guidelines
• Pancreatology

Background:

• Post-ERCP pancreatitis (PEP) is the most frequent complication of endoscopic retrograde cholangiopancreatography (ERCP).
• Advances in ERCP techniques and new research necessitate guideline updates since 2015.
• The guidelines focus on adult patients undergoing ERCP.

Purpose of the Study:

• Provide updated, evidence-based recommendations for PEP prevention, diagnosis, and management.
• Establish a comprehensive framework for clinicians to minimize PEP risk.
• Incorporate the GRADE methodology for guideline development.

Main Methods:

• Utilized the GRADE methodology for evidence assessment and guideline formulation.
• Reviewed procedural and patient-related risk factors for PEP.
• Synthesized current research on diagnostic criteria and treatment protocols for PEP.

Main Results:

• Recommends endoscopic ultrasound for high-risk patients to avoid unnecessary ERCP procedures.
• Highlights that operator experience is less critical than skilled supervision in affecting PEP rates.
• Suggests monitoring serum pancreatic enzyme levels and early CT scans for diagnosis.
• Recommends standard acute pancreatitis treatment protocols.
• Strongly supports temporary pancreatic duct stents and rectal NSAIDs for PEP prevention.

Conclusions:

• The 2023 guidelines offer a robust framework for reducing PEP incidence and improving patient outcomes.
• Evidence-based preventive measures like pancreatic stents and NSAIDs are crucial.
• Adherence to updated diagnostic and management strategies is essential for clinical practice.