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Post-ERCP pancreatitis and its prevention

Nature Clinical Practice Gastroenterology & Hepatology volume 3, pages 680–688 (2006)Cite this article

Abstract

Pancreatitis remains the most common severe complication of endoscopic retrograde cholangiopancreatography (ERCP), and typically develops in 5–7% of patients. Although most post-ERCP pancreatitis (PEP) is mild, severe pancreatitis and its complications (including a systemic inflammatory response or the development of pseudocysts or pancreatic necrosis) can occur, and in rare cases death can result. A means of preventing PEP in all patients who undergo the procedure remains elusive. Proper patient selection for ERCP is critical to avoid unnecessary risk. Pharmacologic attempts to prevent PEP have been largely unsuccessful; encouraging results have been difficult to validate. Prophylactic stenting of the pancreatic duct and minimally traumatic cannulation techniques offer the most promise as a means of preventing PEP. This manuscript reviews risk factors for PEP as well as pharmacologic and procedural means that can be used to reduce its incidence.

Key Points

  • Pancreatitis remains a frequently encountered complication of endoscopic retrograde cholangiopancreatography (ERCP)

  • Proper patient selection is critical to reduce the frequency of post-ERCP pancreatitis (PEP): patients who require diagnostic ERCP or with 'soft' indications for the procedure should be considered for other noninvasive investigations, such as magnetic resonance cholangiopancreatography and endoscopic ultrasound

  • To date, no pharmacologic agent has been definitively shown to reduce the risk of PEP

  • Minimally traumatic cannulation techniques can reduce the risk of PEP

  • Pancreatic duct stenting can reduce the risk of PEP

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Figure 1: Prophylactic pancreatic duct stenting.
Figure 2: Fluoroscopic image of guidewire cannulation.

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Acknowledgements

The authors wish to thank Amy L Adler for her editorial assistance.

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Authors and Affiliations

  1. Gastroenterology Fellow at the University of Texas–Houston Medical School,

    Carl D Frank & Douglas G Adler

  2. Department of Internal Medicine, Division of Gastroenterology, Assistant Professor of Medicine and Director of Therapeutic Endoscopy, University of Utah School of Medicine, Salt Lake City, UT, USA

    Carl D Frank & Douglas G Adler

  3. faculty of the University of Texas–Houston Medical School when this manuscript was written,

    Carl D Frank & Douglas G Adler

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  1. Carl D Frank
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Correspondence to Douglas G Adler.

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Frank, C., Adler, D. Post-ERCP pancreatitis and its prevention. Nat Rev Gastroenterol Hepatol 3, 680–688 (2006). https://doi.org/10.1038/ncpgasthep0654

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