Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis – A Review

Endoscopic retrograde cholangiopancreatography (ERCP) has continued to develop over recent decades with regards to both indications for its use and improvements in technique. The most common complication is post- endoscopic retrograde cholangiopancreatography pancreatitis (PEP) with incidence rates being reported at ~10%. The exact mechanism of PEP is unknown but is likely multi-factorial with papillary edema contributing to the activation of the inflammatory cascade playing an important role. Selected risk factors include patient-related factors (female, sex, younger age, sphincter of Oddi dysfunction, and history of PEP) and procedure-related factors (difficult cannulation, multiple pancreatic duct guidewire passes, pancreatic acinarization, multiple pancreatic duct contrast injections and precut sphincterotomy). Several preventative prophylactic strategies have been posited; however, current guidelines recommend the use of rectal NSAIDs, aggressive IV fluid hydration and pancreatic duct stents. Appropriate patient selection and the use of non-invasive imaging modalities for diagnosis of pancreaticobiliary abnormalities is a key aspect in prevention. Future studies continue to explore various pharmacologic, procedure-related and combination strategies for prevention and will be important as the use of ERCP continues to grow.