Best practices for prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis

Abstract

Acute pancreatitis is of one the most common gastroenterology-related indications for hospital admissions worldwide. With the widespread reliance on endoscopic retrograde cholangiopancreatography (ERCP) for the management of pancreaticobiliary conditions, post-ERCP pancreatitis (PEP) has come to represent an important etiology of acute pancreatitis. Despite many studies aiming to better understand the pathogenesis and prevention of this iatrogenic disorder, findings have been heterogeneous, and considerable variation in clinical practice exists. Herein, we review the literature regarding PEP with the goal to raise awareness of this entity, discuss recent data, and present evidence-based best practices. We believe this manuscript will be useful for gastrointestinal endoscopists as well as other specialists involved in the management of patients with PEP.

Keywords: Post-endoscopic retrograde cholangiopancreatography pancreatitis; Endoscopic retrograde cholangiopancreatography; Pancreatitis; Practice guidelines; Pharmacology; Prevention

Core Tip: Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) represents an important etiology of acute pancreatitis and is the most common major adverse event post-ERCP. Nevertheless, gaps in knowledge remain, as do large variations in clinical practice. Best practices with respect to the prevention of PEP continue to evolve as new evidence becomes available. Herein, we review the literature regarding PEP to increase awareness of this entity, facilitate best practices in PEP prevention and subsequent management, and ultimately improve clinical outcomes.