• gtn
• nsaids
• pep
• post-ercp pancreatitis

• Cholangiopancreatography, Endoscopic Retrograde/adverse effects
• Humans
• Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
• Anti-Inflammatory Agents, Non-Steroidal/administration & dosage
• Nitroglycerin/therapeutic use
• Nitroglycerin/administration & dosage
• Pancreatitis/prevention & control
• Pancreatitis/etiology
• Randomized Controlled Trials as Topic
• Drug Therapy, Combination
• Vasodilator Agents/therapeutic use
• Vasodilator Agents/administration & dosage

• Cholangiopancreatography
• endoscopic retrograde
• pancreatitis
• pharmacological
• prophylaxis
• therapies

• Aged
• Humans
• Middle Aged
• Acute Disease
• Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
• Anti-Inflammatory Agents, Non-Steroidal/adverse effects
• Cholangiopancreatography, Endoscopic Retrograde/adverse effects
• Fluid Therapy/methods
• Network Meta-Analysis
• Pancreatitis/prevention & control
• Pancreatitis/etiology
• Ringer's Lactate/therapeutic use
• Ringer's Lactate/administration & dosage
• Risk Factors
• Somatostatin/analogs & derivatives
• Somatostatin/therapeutic use
• Treatment Outcome

• Humans
• Incidence
• Cholangiopancreatography, Endoscopic Retrograde/adverse effects
• Randomized Controlled Trials as Topic
• Pancreatitis/epidemiology
• Pancreatitis/etiology
• Stents/adverse effects

Acute pancreatitis is the most common and severe complication of endoscopic retrograde cholangiopancreatography (ERCP). Recent evidence suggests that combinations based on rectal nonsteroidal anti-inflammatory drugs (NSAIDs) are more beneficial in preventing post-ERCP pancreatitis (PEP). Randomized controlled trials (RCTs) have also demonstrated the efficacy of glyceryl trinitrate (GTN). We conducted a network meta-analysis to compare NSAIDs and GTN for prevention of PEP and to determine whether they are better in combination.

To compare NSAIDs and GTN for prevention of PEP and to determine whether they are better in combination.

A systematic search was done for full-text RCTs of PEP in PubMed, Embase, Science Citation Index, and the Cochrane Controlled Trials database. Inclusion and exclusion criteria were used to screen for eligible RCTs. The major data were extracted by two independent reviewers. The frequentist model was used to conduct this network meta-analysis and obtain the pairwise OR and 95%CI. The data were then extracted and assessed on the basis of the Reference Citation Analysis (https://www.referencecitationanalysis.com/).

Twenty-four eligible RCTs were selected, evaluating seven preventive strategies in 9416 patients. Rectal indomethacin 100 mg plus sublingual GTN (OR: 0.21, 95%CI: 0.09–0.50), rectal diclofenac 100 mg (0.34, 0.18–0.65), sublingual GTN (0.34, 0.12–0.97), and rectal indomethacin 100 mg (0.49, 0.33–0.73) were all more efficacious than placebo in preventing PEP. The combination of rectal indomethacin and sublingual GTN had the highest surface under the cumulative ranking curves (SUCRA) probability of (92.2%) and was the best preventive strategy for moderate-to-severe PEP with a SUCRA probability of (89.2%).

Combination of rectal indomethacin 100 mg with sublingual GTN offered better prevention of PEP than when used alone and could alleviate the severity of PEP.

• Endoscopic retrograde cholangiopancreatography
• Pancreatitis
• Diclofenac
• Indomethacin
• Naproxen
• Glyceryl trinitrate

Post endoscopic retrograde cholangiopancreatography (ERCP) is comparatively complex application. Researchers has been investigated prevention of post-ERCP pancreatitis (PEP), since it has been considered to be the most common complication of ERCP. Although ERCP can lead various complications, it can also be avoided.

To study the published evidence and systematically review the literature on the prevention and treatment for PEP.

A systematic literature review on the prevention of PEP was conducted using the electronic databases of ISI Web of Science, PubMed and Cochrane Library for relevant articles. The electronic search for the review was performed by using the search terms “Post endoscopic retrograde cholangiopancreatography pancreatitis” AND “prevention” through different criteria. The search was restricted to randomized controlled trials (RCTs) performed between January 2009 and February 2019. Duplicate studies were detected by using EndNote and deleted by the author. PRISMA checklist and flow diagram were adopted for evaluation and reporting. The reference lists of the selected papers were also scanned to find other relevant studies.

726 studies meeting the search criteria and 4 relevant articles found in the edited books about ERCP were identified. Duplicates and irrelevant studies were excluded by screening titles and abstracts and assessing full texts. 54 studies were evaluated for full text review. Prevention methods were categorized into three groups as (1) assessment of patient related factors; (2) pharmacoprevention; and (3) procedural techniques for prevention. Most of studies in the literature showed that young age, female gender, absence of chronic pancreatitis, suspected Sphincter of Oddi dysfunction, recurrent pancreatitis and history of previous PEP played a crucial role in posing high risks for PEP. 37 studies designed to assess the impact of 24 different pharmacologic agents to reduce the development of PEP delivered through various administration methods were reviewed. Nonsteroidal anti-inflammatory drugs are widely used to reduce risks for PEP. Rectal administration of indomethacin immediately prior to or after ERCP in all patients is recommended by European Society for Gastrointestinal Endoscopy guidelines to prevent the development of PEP. The majority of the studies reviewed revealed that rectally administered indomethacin had efficacy to prevent PEP. Results of the other studies on the other pharmacological interventions had both controversial and promising results. Thirteen studies conducted to evaluate the efficacy of 4 distinct procedural techniques to prevent the development of PEP were reviewed. Pancreatic Stent Placement has been frequently used in this sense and has potent and promising benefits in the prevention of PEP. Studies on the other procedural techniques have had inconsistent results.

Prevention of PEP involves multifactorial aspects, including assessment of patients with high risk factors for alternative therapeutic and diagnostic techniques, administration of pharmacological agents and procedural techniques with highly precise results in the literature.

• Endoscopic retrograde cholangiopancreatography
• Pancreatitis
• Prevention
• Treatment
• Indomethacin
• Stent replacement
• Prophylaxis

• Administration, Rectal
• Anti-Inflammatory Agents/administration & dosage
• Biliary Tract Diseases/surgery
• Catheterization/instrumentation
• Catheterization/methods
• Cholangiopancreatography, Endoscopic Retrograde/adverse effects
• Drainage/instrumentation
• Drainage/methods
• Humans
• Pancreas/drug effects
• Pancreas/metabolism
• Pancreas/surgery
• Pancreatitis/etiology
• Pancreatitis/therapy
• Phosphodiesterase 5 Inhibitors/administration & dosage
• Postoperative Complications/etiology
• Postoperative Complications/therapy
• Preoperative Care/methods
• Risk Assessment
• Risk Factors
• Somatostatin/administration & dosage
• Sphincter of Oddi/drug effects
• Sphincter of Oddi/surgery
• Stents

• Age Distribution
• Chemoprevention/methods
• Cholangiopancreatography, Endoscopic Retrograde/adverse effects
• Cholangiopancreatography, Endoscopic Retrograde/methods
• Female
• Humans
• Male
• Middle Aged
• Pancreatitis/etiology
• Pancreatitis/prevention & control
• Risk Factors
• Sex Distribution

• CBD cannulation
• glucagon
• nitroglycerin
• post-ERCP pancreatitis

• ERCP
• Medications
• Pancreatitis
• Prevention
• Stents

• Drug
• Outcome
• Pancreas
• Post-ERCP

• Cannulation
• Indomethacin
• Manometry
• Pancreatic stents
• Pancreatitis
• Precut
• Sphincter of Oddi dysfunction
• Sphincterotomy

Distal (lower) bile duct cancers arise in the lower half of the biliary tree closer to the small intestine. Biliary disease complicated with cholangiobronchopleural fistula, which may occur in cases of multiple hepatobiliary stones or biliary ascariasis-associated severe infection, has rarely been reported in the literature, particularly following endoscopic retrograde cholangiopancreatography (ERCP). The present study describes the case of a 60-year-old female with distal cholangiocarcinoma complicated with cholangiobronchopleural fistula after ERCP for this rare disease. This complication was likely due to the inability to control retrograde infection following ERCP and, thus, the infection was disseminated. This resulted in mixed infection involving the diaphragm and pleura, and further penetrating the bronchus. The patient was managed with pancreatoduodenectomy and has since remained in good health.

• cholangiobronchopleural fistula
• distal cholangiocarcinoma
• endoscopic retrograde cholangiopancreatography

• Acute pancreatitis
• Endoscopic retrograde cholangio pancreatography

Post-procedure pancreatitis is the most common complication of endoscopic retrograde cholangio pancreatography (ERCP) and carries a high morbidity and mortality occurring in at least 3%-5% of all procedures. We reviewed the available literature searching for “ERCP” and “pancreatitis” and “post-ERCP pancreatitis”. in PubMed and Medline. This review looks at the diagnosis, risk factors, causes and methods of preventing post-procedure pancreatitis. These include the evidence for patient selection, endoscopic techniques and pharmacological prophylaxis of ERCP induced pancreatitis. Selecting the right patient for the procedure by a risk benefits assessment is the best way of avoiding unnecessary ERCPs. Risk is particularly high in young women with sphincter of Oddi dysfunction (SOD). Many of the trials reviewed have rather few numbers of subjects and hence difficult to appraise. Meta-analyses have helped screen for promising modalities of prophylaxis. At present, evidence is emerging that pancreatic stenting of patients with SOD and rectally administered nonsteroidal anti-inflammatory drugs in a large unselected trial reduce the risk of post-procedure pancreatitis. A recent meta-analysis have demonstrated that rectally administered indomethecin, just before or after ERCP is associated with significantly lower rate of pancreatitis compared with placebo [OR = 0.49 (0.34-0.71); P = 0.0002]. Number needed to treat was 20. It is likely that one of these prophylactic measures will begin to be increasingly practised in high risk groups.

• Acute pancreatitis
• Endoscopic retrograde cholangio pancreatography

• Catheterization/methods
• Cholangiopancreatography, Endoscopic Retrograde/adverse effects
• Humans
• Nitroglycerin/pharmacology
• Pancreatitis/etiology
• Pancreatitis/prevention & control
• Prospective Studies
• Randomized Controlled Trials as Topic/methods

AIM: To investigate the preventive effect of somatostatin versus endoscopic nasal biliary drainage (ENBD) on post-ERCP pancreatitis (PEP) and hyperamylasemia.

METHODS: A total of 110 patients were enrolled and randomly divided into 3 groups to receive somatostatin, ENBD or placebo. Incidences of PEP, hyperamylasemia and adverse reactions were observed.

RESULTS: The overall incidences of PEP and hyperamylasemia were 17.2% (19/110) and 4.54% (5/110), respectively. The levels of serum amylase at 6 h in the somatostatin group and ENBD group were significantly lower than that in the control group (467 IU/L ± 63 IU/L 501 IU/L ± 405 IU/L vs 1 323 IU/L ± 46 IU/L, both P < 0.05), while the levels of serum amylase at 24 h showed no significant differences among the three groups (P > 0.05). The time to disappearance of abdominal symptoms, the time to recovery of blood parameters, and average length of hospital stay in the somatostatin group and ENBD group were significantly shorter than those in the control group (all P < 0.05). The costs were significantly lower in the somatostatin group than in the ENBD group (P < 0.05).

CONCLUSION: Both somatostatin and ENBD can effectively prevent post-ERCP pancreatitis and hyperamylasemia, and somatostatin is associated with lower medical expenses.

• Somatostatin
• Endoscopic nasal biliary drainage
• Endoscopic retrograde cholangiopancreatography
• Pancreatitis
• Hyperamylasemia

• Cholangiopancreatography, Endoscopic Retrograde/adverse effects
• Glycoproteins/therapeutic use
• Humans
• Hyperamylasemia/etiology
• Hyperamylasemia/prevention & control
• Pancreatitis/etiology
• Pancreatitis/prevention & control
• Randomized Controlled Trials as Topic
• Trypsin Inhibitors/therapeutic use

Glyceryl trinitrate (GTN) has been shown to be able to relax the sphincter of Oddi (SO) both in animals and humans. Theoretically, the use of these compounds during and after endoscopic retrograde cholangiopancreatgraphy (ERCP) could relax the biliary and pancreatic sphincters, facilitating cannulation of common bile duct (CBD) during the procedure, or minimizing potential pancreatic outflow obstruction after the procedure. However, clinical trials evaluating the protective effect of GTN on the post-endoscopic retrograde cholangiopancreatgraphy pancreatitis (PEP) have yielded inconclusive results. This meta-analysis is to systematically assess the effect of prophylactic administration of glyceryl trinitrate (GTN) on the prevention of PEP and the effect on the cannulation of bile ducts.

By searching PubMed (1966 to September 2009), CENTRAL (Cochrane Controlled trials Register; issue 3, 2009) and EMBASE.com (1984 to September 2009), two independent reviewers systematically identified prospective randomized controlled trials (RCTs) detecting the effect of prophylactic GTN on the incidence of PEP and on the cannulation of bile ducts. A meta-analysis of these clinical trials was then performed.

There are 55/899(6.1%) patients suffering PEP in the treatment group versus 95/915(10.4%) patients in the placebo group. The overall pooled risk of PEP was significantly lower in the GTN group than in the placebo group (OR 0.56, 95% CI: 0.40 to 0.79, p = 0.001). Subgroup analyses suggested that GTN administered by the sublingual form (OR 0.34,95% CI:0.16 to 0.75, p = 0.007) is more effective than transdermal route(OR 0.64,95% CI:0.40 to 1.01, p = 0.05), and the protective effect of GTN was far more obvious in the centers with high incidence of PEP (OR 0.40, 95% CI:0.24 to 0.67, p = 0.0006) than those centers with a low incidence of PEP (OR 0.75, 95% CI: 0.47 to 1.20, p = 0.22). Additionally, the meta-analysis suggests that GTN was not helpful for the cannulation of bile ducts.

We concluded that prophylactic administration of GTN may significantly reduce the incidence of PEP and not be helpful for the cannulation of bile ducts.