• cholangiopancreatography
• complication
• pancreatitis

The resulting pain is the main symptom of acute pancreatitis and it should be alleviated as soon as possible. NSAIDs are the first line therapy for pain and they are generally administered to acute pancreatitis patients upon admission to the hospital. In addition, these drugs have also been used to prevent post-endoscopic cholangiopancreatography (ERCP) acute pancreatitis. On the other hand, there are several reports indicating that NSAIDs may be the actual cause of acute pancreatitis. We carried out a literature search on PubMed/MEDLINE; all full text papers published in from January 1966 to November 2009 on the use of NSAIDs in acute pancreatitis were collected; the literature search was also supplemented by a review of the bibliographies of the papers evaluated. Thus, in this article, we will systematically review the current literature in order to better illustrate the role of NSAIDs in acute pancreatitis, in particular: i) NSAIDs as a cause of acute pancreatitis; ii) their use to prevent post-retrograde ERCP pancreatitis and iii) their efficacy for pain relief in the acute illness of the pancreas.

• acute pancreatitis
• arachidonic acid
• cytokines
• inflammation
• leukotrienes
• phospholipase A2
• prostaglandins

Pancreatitis is the most common complication after endoscopic retrograde cholangio-pancreatography (ERCP); the reported incidence of this complication varies from less than 1% to 40%, but a rate of 4%-8% is reported in most prospective studies involving non-selected patients. Differences in criteria for defining pancreatitis, methods of data collection, and patient populations (i.e. number of high-risk patients included in the published series) are factors that are likely to affect the varying rates of post-ERCP pancreatitis. The severity of post-ERCP pancreatitis (PEP) can range from a minor inconvenience with one or two days of added hospitalization with full recovery to a devastating illness with pancreatic necrosis, multiorgan failure, permanent disability, and even death. Although, most episodes of PEP are mild (about 90%), a small percentage of patients (about 10%) develop moderate or severe pancreatitis. In the past, PEP was often viewed as an unpredictable and unavoidable complication, with no realistic strategy for its avoidance. New data have aided in stratification of patients into PEP risk categories and new measures have been introduced to decrease the risk of PEP. As most ERCPs are performed on an outpatient basis, the majority of patients will not develop PEP and can be discharged. Alternatively, early detection of those patients who will go on to develop PEP can guide decisions regarding hospital admission and aggressive management. In the last decade, great efforts have been addressed toward prevention of this complication. Points of emphasis have included technical measures, pharmacological prophylaxis, and patient selection. This review provides a comprehensive, evidence-based assessment of published data on PEP and current suggestions for its avoidance.

• Endoscopic retrograde cholangiopan-creatography
• Post-ERCP pancreatitis

• Amylases/blood
• Cholangiopancreatography, Endoscopic Retrograde/adverse effects
• Humans
• Lipase/blood
• Pancreas/enzymology
• Pancreas/pathology
• Pancreatitis/blood
• Pancreatitis/etiology
• Pancreatitis/prevention & control
• Predictive Value of Tests
• Risk Factors

• Biomarkers/blood
• C-Reactive Protein/metabolism
• Gastrointestinal Diseases/blood
• Humans
• Inflammation/blood

• Adult
• Amylases/blood
• C-Reactive Protein/analysis
• Cholangiopancreatography, Endoscopic Retrograde/adverse effects
• Female
• Humans
• Hydrogen Peroxide/blood
• Interleukin-6/blood
• Leukocyte Count
• Lipase/blood
• Lipid Peroxidation
• Male
• Malondialdehyde/blood
• Pancreatitis/etiology
• Reactive Oxygen Species/metabolism