Khayyat YM. Non-endoscopic strategies to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis. World J Gastrointest Endosc 2026; 18(4): 117983 [DOI: 10.4253/wjge.v18.i4.117983]
Corresponding Author of This Article
Yasir M Khayyat, FACG, FACP, FRCP (C), Professor, Department of Medicine, Faculty of Medicine, Umm AL-Qura University, AlAwali District, Makkah 8156-24381, Saudi Arabia. ymkhayyat@uqu.edu.sa
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Editorial
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World J Gastrointest Endosc. Apr 16, 2026; 18(4): 117983 Published online Apr 16, 2026. doi: 10.4253/wjge.v18.i4.117983
Non-endoscopic strategies to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis
Yasir M Khayyat
Yasir M Khayyat, Department of Medicine, Faculty of Medicine, Umm AL-Qura University, Makkah 8156-24381, Saudi Arabia
Author contributions: Khayyat YM performed literature review, collection, initial drafting, and final review of the manuscript.
Conflict-of-interest statement: The author declared that there was no conflict of interest to disclose.
Corresponding author: Yasir M Khayyat, FACG, FACP, FRCP (C), Professor, Department of Medicine, Faculty of Medicine, Umm AL-Qura University, AlAwali District, Makkah 8156-24381, Saudi Arabia. ymkhayyat@uqu.edu.sa
Received: December 22, 2025 Revised: January 14, 2026 Accepted: February 4, 2026 Published online: April 16, 2026 Processing time: 113 Days and 22.6 Hours
Abstract
Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is a significant complication of endoscopic retrograde cholangiopancreatography. Its pathogenesis is multifactorial, with elevated intraductal hydrostatic pressure as a primary cause. I read with interest and commend Amalou et al recently published a study in World Journal of Gastrointestinal Endoscopy for their study on the prevention of PEP using lactated Ringer’s (LR) solution in combination with indomethacin. The editorial focuses on non-endoscopic strategies for PEP prevention, critically evaluating the currently available evidence. Rectal administration of non-steroidal anti-inflammatory drugs (NSAIDs) is an established cornerstone of pharmacological prophylaxis due to robust evidence of efficacy, safety, and cost-effectiveness. Aggressive periprocedural intravenous hydration with LR solution has also demonstrated benefit in reducing the incidence and severity of PEP, although its incremental value when combined with rectal NSAIDs has achieved mixed results in large trials. Such a combination may offer advantages, particularly for moderate-to-severe PEP, but is not universally superior to NSAID monotherapy. Prophylaxis should be stratified according to patient risk. Future directions should aim to optimize risk prediction and personalize prophylactic protocols to improve clinical implementation and patient outcomes.
Core Tip: Prophylaxis for post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) should be stratified according to patient risk. Rectal non-steroidal anti-inflammatory drugs (NSAIDs) are the foundational, evidence-based intervention recommended for all patients. In high-risk individuals, the combination of rectal NSAIDs with aggressive intravenous lactated Ringer’s hydration is beneficial, particularly for reducing moderate-to-severe PEP. Prophylactic stenting of the pancreatic duct remains a key endoscopic strategy in high-risk cases. A universal, risk-adapted approach utilizing these non-endoscopic (medication and hydration) and endoscopic (stenting) measures is essential for effective prevention.
