Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most informative and often in-demand methods for the detection and treatment of pathology of the biliary tract, its diagnostic value is 79-98%. A significant disadvantage of the method are side effects and various complications (acute pancreatitis, bleeding, retroduodenal perforation, cholangitis, acute cholecystitis, etc.). Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is a common and severe complication of intraluminal endoscopic operations on the large duodenal papilla, its etiology is multifactorial, and the pathophysiology has not yet been fully studied. According to many randomized, controlled studies, the incidence of PEP ranges from 2.7 to 37%. Despite all the possibilities of modern medicine and the introduction of new methods, mortality with the development of PEP remains at a very high level: it reaches 7-15%, and with the development of destructive forms - 40-70%. The problems of prevention of PEP are still the subject of discussions and numerous studies by leading clinics around the world. In this paper, we conducted a review of the literature over the past decade using the sources of major medical libraries Medline, eLibrary, PubMed. The article discusses current modern pathogenetic mechanisms and the main risk factors for the development of PEP, related to both the characteristics of the patient and the procedure being performed, technical options for performing ERCP. The article also presents currently used and recommended by most authors methods of drug prevention of PEP and various technical solutions related to this complication. Thus, the not entirely satisfactory results of the proposed methods of prevention of PEP force the authors to search for safer and more effective solutions to this urgent problem at the present time.

The article is devoted to the evaluation of methods for the prevention of post-manipulation pancreatitis based on the analysis of hyperamylasemia in patients with acute biliary pancreatitis, who underwent transpapillary interventions.Aim of the study. To assess the impact of a new method of preventing post-manipulation complications on the rate of regression of hyperamylasemia in acute biliary pancreatitis.Materials and methods. In 2015-2021, 70 patients with proven acute biliary pancreatitis who underwent transpapillary interventions were included. Men -16 (23%), women 54 (77%). In 56 patients (Group 1), complications were prevented after the intervention by submucosal infi ltration of a 0.5% lidocaine/novocaine solution, 10 ml. 14 patients (Group 2) used the new technique in the prevention of complications (priority certifi cate No. 2021137430 dated 12/16/2021). The level of amylasemia was monitored 6-8 hours after papillotomy, then daily until normalization. In 10 patients of the 2nd group, stenting with a plastic stent was also used.Results. The time for regression of hyperamylasemia to 100 units/l between groups 1 and 2 was 6.8±1.9 days versus 4.5±2.3 and diff ered signifi cantly. Without a stent, the level of amylasemia in the 2nd group returned to normal within 2 days, with the use of a stent -within 4 days, without statistical diff erences. Evaluation of the rate of regression of reactive hyperamylasemia in patients with normal amylase levels at the time of endoscopic intervention revealed a reduction in the duration of the period of hyperamylasemia when using double PBB. Comparison of the rate of regression of hyperamylasemia in acute biliary pancreatitis with conventional PBB with changes in reactive hyperamylasemia after EPT without PBB showed a similar picture. Conclusions.1. A new technique for the prevention of post-manipulation complications is promising and requires additional evaluation. 2. PBB after the intervention does not signifi cantly aff ect the rate of regression of hyperamylasemia. 3. Stenting of the pancreatic duct in acute biliary pancreatitis tends to prolong the duration of hyperamylasemia.