Prevention of post-ERCP pancreatitis: a comprehensive review

Practice Guidelines in Acute Pancreatitis

“…Empiric biliary sphincterotomy and even diagnostic ERCP in patients with recurrent pancreatitis, and especially those with suspected sphincter of Oddi dysfunction, are associated with significantly greater risk of post-ERCP pancreatitis, and are less likely to be of therapeutic benefit than for patients with biliary pancreatitis (246)(247)(248)(249)(250). ERCP in such patients may be best approached in the context of a more comprehensive evaluation using other imaging techniques including MRCP and EUS, and risk of post-ERCP pancreatitis may be reduced by placement of a temporary small-caliber pancreatic stent (207,265).…”

ERCP Educational Guidelines for Fellows

“…The rate of ERCP-induced pancreatitis is generally reported to be approximately 1% to 7% (30)(31)(32). Patient selection and physician experience (24,33) are critical aspects in minimizing complications and maximizing procedural success.…”

“…The expected rate of major postsphincterotomy bleeding is approximately 2% (6,30,32). Risk factors for postsphincterotomy bleeding include the presence of hemodialysis, bleeding at the time of the sphincterotomy, active cholangitis, abnormal coagulation status and low endoscopist case volume (less than one case per week) (30,34).…”

“…Cholangitis has been reported in 1% or fewer and cholecystitis in 0.2% to 0.5% of ERCP procedures (6,31), while the overall incidence of perforation has been reported to be less than 1% in patients with normal anatomy (6,32). The use of pancreatic stents to prevent pancreatitis and avoidance of precut sphincterotomy (ie, more skilled at selective cannulation) are two newer methods that might decrease risk, yet add complexity to the case (27,29).…”

The postcholecystectomy syndrome: a review of etiology and current approaches to management

“…This is particularly true for patients with Type III SOD, whose response to EBS approaches only 37% even after abnormal SOM. 25 Given the high risk of ERCPrelated pancreatitis, which is 2-9% in unselected series and as high as 10-30% in cases of suspected SOD, [26][27] the role of ERCP and SOM in this subset of patients is still a subject of debate. In a recent cohort study, 54% of patients with suspected Type II or III SOD underwent ERCP and SOM and were found to have normal SOM, and 12% developed procedure-related pancreatitis.…”