Prevention of post-ERCP pancreatitis

Table 1 Consensus definition of post-endoscopic retrograde cholangio pancreatography pancreatitis

Severity ofpancreatitis	Definition
Mild	Clinical pancreatitis, amylase at least 3 × normal > 24 h after procedure, requiring unplanned admission or prolongation of planned admission to 2-3 d
Moderate	Hospitalisation of 4-10 d
Severe	Hospitalisation of > 10 d, haemorrhagic pancreatitis, pancreatic necrosis or pseudocyst, or need for intervention (percutaneous drainage or surgery)

Table 2 Risk factors for post-endoscopic retrograde cholangio pancreatography pancreatitis

Risk factors for post ERCP pancreatitis
Patient-related factors	Younger age
	Female sex
	Normal serum bilirubin
	Recurrent pancreatitis
	Prior ERCP-induced pancreatitis
	Sphincter of Oddi dysfunction
Endoscopist-related factors	Difficult cannulation
	Pancreatic duct injection
	Sphincter of Oddi manometry
	Precut sphincterotomy
	Pancreatic sphincterotomy
	Minor papilla sphincterotomy
Procedure-related factors	Trainee involvement in procedure

ERCP: Endoscopic retrograde cholangio pancreatography.

Table 3 Pharmacological agents studied according to postulated mechanism of action

Postulated mechanismof action	Agents
Interruption of inflam matory cascade	NSAIDs, steroids, interleukin-10, allopurinol, adrenaline spray, pentoxifylline, platelet-activating factor-acetylhidrolase, semapimod, aprepitant, risperidone
Reduction of pancreatic enzyme secretion	Octreotide, somatostatin, calcitonin
Inhibition of protease activity	Gabexate mesilate, heparin, ulinastatin, nafamostat, magnesium sulphate
Reduction of Sphincter- of-Oddi pressure	Nitroglycerin, nifedipine, botulinum toxin, lidocaine, secretin, phosphodiesterase inhibitor type 5
Prevention of infection	Antibiotics
Anti-oxidants	Beta-carotene, N-acetylcysteine, sodium selenite
Anti-metabolites	5-fluorouracil

NSAIDs: Non-steroidal anti-inflammatory drugs.