Pancreatic Duct Variations and the Risk of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) is an important diagnostic and therapeutic procedure in the management of biliary and pancreatic disorders. Despite advances in ERCP facilities and techniques, pancreatitis remains the most common and feared complication of this procedure. The technical challenges of ERCP could be further compounded by variations in the configuration of the pancreatic ductal system. As a result, the knowledge of these variations and their potential role in the development of post-ERCP pancreatitis (PEP) is essential to any successful risk reduction strategy. This review provides an overview of the anatomy and embryological basis of pancreatic duct variations, as well as explore the different types and prevalence of these variations. Also, we discuss the mechanisms of PEP and provide evidence supporting a link between the variations and PEP using published data

Factores asociados a pancreatitis posterior a colangiopancreatografía retrógrada endoscópica: experiencia de un centro del caribe colombiano

“…En cuanto al uso de herramientas farmacológicas y técnicas preventivas casi la totalidad proviene de países de altos ingresos, y no son aplicables en el contexto y la dinámica de los servicios de salud en Latinoamérica y el Caribe. Por ejemplo, Ojo A (18) indagó sobre las variaciones anatómicas del páncreas y el riesgo de pancreatitis post-CPRE, determinando que tener un páncreas anular, duplicaciones, dilatación quística del ducto pancreático y la formación de un ducto aberrante pancreatobiliar, son factores de riesgo para presentar complicaciones durante la CPRE, y que son anormalidades prevenibles debido a que se necesitaría que todo paciente que sea sometido a CPRE, sea evaluado previamente para identificar la integridad pancreática (18). No obstante, esto no es viable en todos los sistemas de salud ni hospitales de mediana o baja complejidad, toda vez que dependería de factores externos al servicio, tal y como se observó en los resultados de este estudio, donde se realizó el procedimiento con el objetivo terapéutico de corregir, principalmente, enfermedad litiásica biliar.…”

Post-endoscopic retrograde cholangiopancreatography pancreatitis: a review

“…In no specific order, these include female sex, younger age (<50 years), SOD (by nearly fivefold), pancreas divisum, pancreaticobiliary malignancy, history of PEP, history of acute pancreatitis, difficult cannulation (with either repetitive attempts or a longer time interval prior to cannulation) and normal serum bilirubin levels. [6,10,26,27] Pregnancy has also been shown to be an independent risk factor. [28] Interestingly, chronic pancreatitis has been shown to be protective potentially due to chronic pancreatic enzyme exposure and atrophy.…”