Post-endoscopic retrograde cholangiopancreatography pancreatitis: A systematic review for prevention and treatment

Abstract

BACKGROUND 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. AIMS To study the published evidence and systematically review the literature on the prevention and treatment for PEP. METHODS 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. RESULTS 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. CONCLUSION Prevention of PE...

Sex-Related Differences of Acute and Chronic Pancreatitis in Adults

“…It has been suggested that other risk factors may increase the risk of post-ERCP pancreatitis synergistically. For instance, Sphincter of Oddi dysfunction, an independent risk factor for the development of post-ERCP pancreatitis, is more common in women overall, which could make the actual association between women and post-ERCP pancreatitis difficult to distinguish [ 56 ]. Furthermore, Freeman et al found the highest risk of post-ERCP pancreatitis (42%) in female patients with normal serum bilirubin, Sphincter of Oddi dysfunction, and difficult biliary cannulation [ 50 ].…”

Temporal trends and mortality of post-ERCP pancreatitis in the United States: a nationwide analysis

“…[2][3][4][5][6] Consequently, multiple pharmacological and procedural interventions have been used by endoscopists to reduce the risk of PEP over the last few decades. [7][8][9][10][11] These include but are not limited to administration of rectal NSAIDs, infusion of lactated ringers, use of topical epinephrine, placement of pancreatic duct stents and use of guidewire cannulation.…”

Multidisciplinary Approach to Malignant Biliary Obstruction

“…The rate of pancreatitis varies widely in the literature but is around 5% with the vast majority being mild, and instances of severe pancreatitis range between 0.1 and 0.5%. 18,19 Other complications of ERCP include infection, intestinal perforation, and hemorrhage if a sphincterotomy is performed.…”