Post-ERCP Pancreatitis: Prevention, Diagnosis and Management

Cahyadi, Oscar; Tehami, Nadeem; de–Madaria, Enrique; Siau, Keith

doi:10.3390/medicina58091261

Cited by 47 publications

(34 citation statements)

References 87 publications

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“…This study aimed to assess the risk of PEP associated with different canulation techniques. We found the general rate of PEP in our institution to be 9.9%, which was within the previously reported range [1][2][3][4][23][24][25].…”

Section: Discussionsupporting

confidence: 90%

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The Relation between Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis and Different Cannulation Techniques: The Experience of a High-Volume Center from North-Eastern Romania

Chiriac

Sfarti

Stanciu

et al. 2023

Life

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Background: Despite numerous advances that have aimed to increase the safety of endoscopic retrograde cholangiopancreatography (ERCP), post-ERCP pancreatitis (PEP) still remains a major issue. We aimed to assess the rate of PEP as well as the relation to the cannulation techniques in our unit, a high-volume center in north-eastern Romania. Methods: ERCPs performed in our unit from March to August 2022 were retrospectively included. Data concerning demographic information, presence of difficult cannulation, the technique used for cannulation, as well as immediate complications, were gathered from the electronic database. Results: 233 ERCPs were included. PEP was diagnosed in 23 (9.9%) of cases. Precut sphincterotomy (PS), transpancreatic sphincterotomy (TPBS), and a combination of TPBS and PS were performed in 6.4%, 10.3%, and 1.7% of cases, respectively, while an Erlangen precut papillotomy was performed in one case. Both in patients with PS and TPBS the rate of PEP was 20%. When the two techniques were associated, the rate of PEP was 25%. TPBS and PS represented risk factors for PEP (OR 1.211 for a CI of 0.946–1.551, p = 0.041, and OR 1.124 for a CI of 0.928–1.361, p = 0.088, respectively). No PEP-associated deaths were found. Conclusions: Both PS and TPBS presented a similar risk of PEP.

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Section: Discussionsupporting

confidence: 90%

“…The median age of the subjects was 68 years old (57-76), and there were 119 (51.1%) women. The median body mass index (BMI) was 23 kg/m 2 (21)(22)(23)(24). Periampullary diverticula (PAD) were present in 27 (11.5%) of the cases.…”

Section: Patientsmentioning

confidence: 99%

The Relation between Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis and Different Cannulation Techniques: The Experience of a High-Volume Center from North-Eastern Romania

Chiriac

Sfarti

Stanciu

et al. 2023

Life

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“…In the study, EUS showed 100% sensitivity, 88.2% specificity while MRCP showed 33.3% sensitivity, 84.6% specificity. [39,40] However, other studies have not found a similar difference and the noninvasive nature of MRCP certainly makes it a preferred option in certain patients who might be at higher risk. [41,42] Given the increasing complexity of therapeutic ERCP procedures and an increasing incidence of PEP noted from 2011 to 2017, thoughtful patient selection is crucial.…”

Section: Preventionmentioning

confidence: 99%

Post-endoscopic retrograde cholangiopancreatography pancreatitis: a review

Patel,

Akshintala

2023

Journal of Pancreatology

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Endoscopic retrograde cholangiopancreatography (ERCP) has continued to develop over recent decades with regards to both indications for its use and improvements in technique. The most common complication is post- endoscopic retrograde cholangiopancreatography pancreatitis (PEP) with incidence rates being reported at ~10%. The exact mechanism of PEP is unknown but is likely multi-factorial with papillary edema contributing to the activation of the inflammatory cascade playing an important role. Selected risk factors include patient-related factors (female, sex, younger age, sphincter of Oddi dysfunction, and history of PEP) and procedure-related factors (difficult cannulation, multiple pancreatic duct guidewire passes, pancreatic acinarization, multiple pancreatic duct contrast injections and precut sphincterotomy). Several preventative prophylactic strategies have been posited; however, current guidelines recommend the use of rectal NSAIDs, aggressive IV fluid hydration and pancreatic duct stents. Appropriate patient selection and the use of non-invasive imaging modalities for diagnosis of pancreaticobiliary abnormalities is a key aspect in prevention. Future studies continue to explore various pharmacologic, procedure-related and combination strategies for prevention and will be important as the use of ERCP continues to grow.

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“…Minimally invasive treatments are on the rise because of developments in science and medical technology. A typical treatment is endoscopic retrograde cholangiopancreatography (ERCP) in conjunction with lithotomy [ 5 ]. To start, endoluminal cholangiopancreatography (ERCP) is useful for surgical procedures since it may clearly and comprehensively provide angiographic pictures of the biliary tract.…”

Section: Introductionmentioning

confidence: 99%