Saito H, Fujimoto A, Oomoto K, Kadowaki Y, Tada S. Current approaches and questions yet to be resolved for the prophylaxis of post-endoscopic retrograde cholangiopancreatography pancreatitis. World J Gastrointest Endosc 2022; 14(11): 657-666 [PMID: 36438884 DOI: 10.4253/wjge.v14.i11.657]
Corresponding Author of This Article
Hirokazu Saito, MD, Doctor, Department of Gastroenterology, Kumamoto City Hospital, 4-1-60, Higashimachi, Higashi-ku, Kumamoto City 862-8505, Kumamoto, Japan. arnestwest@yahoo.co.jp
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Opinion Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. Nov 16, 2022; 14(11): 657-666 Published online Nov 16, 2022. doi: 10.4253/wjge.v14.i11.657
Current approaches and questions yet to be resolved for the prophylaxis of post-endoscopic retrograde cholangiopancreatography pancreatitis
Hirokazu Saito, Atsushi Fujimoto, Kana Oomoto, Yoshitaka Kadowaki, Shuji Tada
Hirokazu Saito, Atsushi Fujimoto, Kana Oomoto, Yoshitaka Kadowaki, Shuji Tada, Department of Gastroenterology, Kumamoto City Hospital, Kumamoto City 862-8505, Kumamoto, Japan
Author contributions: Saito H, Fujimoto A, Oomoto K, Kadowaki Y, and Tada S have been involved equally and have read and approved the final manuscript; Saito H, Fujimoto A, Oomoto K, Kadowaki Y, and Tada S meet the criteria for authorship established by the International Committee of Medical Journal Editors and verify the validity of the results reported.
Conflict-of-interest statement: There are no conflicts of interest to declare in relation to this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hirokazu Saito, MD, Doctor, Department of Gastroenterology, Kumamoto City Hospital, 4-1-60, Higashimachi, Higashi-ku, Kumamoto City 862-8505, Kumamoto, Japan. arnestwest@yahoo.co.jp
Received: August 14, 2022 Peer-review started: August 14, 2022 First decision: September 26, 2022 Revised: October 6, 2022 Accepted: October 25, 2022 Article in press: October 25, 2022 Published online: November 16, 2022 Processing time: 91 Days and 20.1 Hours
Abstract
Prophylaxis is important for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP), which is the most common and serious complication of ERCP. Although the current guidelines include independent patient- and procedure-related risk factors for PEP and available PEP prophylactic measures, the synergistic effect of these risk factors on PEP should also be considered, given that patients often harbor multiple risk factors. Furthermore, a combination of prophylactic measures is often selected in clinical practice. However, established methods estimating the synergistic effect of independent risk factors on PEP incidence are lacking, and evidence on the impact of combining prophylactic measures on PEP should be discussed. Selection of appropriate candidate patients for ERCP is also important to reduce the incidence of PEP associated with unnecessary ERCP. ERCP indications in patients with asymptomatic common bile duct stones (CBDSs) and in those with suspected CBDSs with no imaging-based evidence of stones are controversial. Further studies are warranted to predict the synergistic effect of independent risk factors on PEP, determine the best prophylactic PEP measures, and identify appropriate candidates for ERCP in patients with asymptomatic CBDSs and those with suspected CBDSs.
Core Tip: To date, there are no established methods to estimate the synergistic effect of the independent risk factors on post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP), and evidence of the efficacy of the combination of prophylactic measures for PEP should be discussed. Furthermore, ERCP indications in patients with asymptomatic common bile duct stones (CBDSs) and patients with suspected CBDS without evidence of stones by imaging are controversial. Further studies are warranted to estimate the synergistic effect of independent risk factors on PEP and to determine the best prophylactic measures as well as the appropriate candidates for ERCP among patients with asymptomatic CBDS and those with suspected CBDS.
