Prevention of post-ERCP pancreatitis: current strategies and novel perspectives

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) is an advanced endoscopic procedure that might lead to severe adverse events. Post-ERCP pancreatitis (PEP) is the most common post-procedural complication, which is related to significant mortality and increasing healthcare costs. Up to now, the prevalent approach to prevent PEP consisted of employing pharmacological and technical expedients that have been shown to improve post-ERCP outcomes, such as the administration of rectal nonsteroidal anti-inflammatory drugs, aggressive intravenous hydration, and the placement of a pancreatic stent. However, it has been reported that PEP originates from a more complex interaction of procedural and patient-related factors. Appropriate ERCP training has a pivotal role in PEP prevention strategy, and it is not a chance that a low PEP rate is universally considered one of the most relevant indicators of proficiency in ERCP. Scant data on the acquisition of skills during the ERCP training are currently available, although some efforts have been recently done to shorten the learning curve by way of simulation-based training and demonstrate competency by meeting technical requirements as well as adopting skill evaluation scales. Besides, the identification of adequate indications for ERCP and accurate pre-procedural risk stratification of patients might help to reduce PEP occurrence regardless of the endoscopist’s technical abilities, and generally preserve safety in ERCP. This review aims at delineating current preventive strategies and highlighting novel perspectives for a safer ERCP focusing on the prevention of PEP.

Prediction for post-ERCP pancreatitis in non-elderly patients with common bile duct stones: a cross-sectional study at a major Chinese tertiary hospital (2015–2023)

“…The complications after ERCP-related procedures mainly include asymptomatic hyperamylaseemia, pancreatitis, cholangitis, cholecystitis, perforation, bleeding, etc., and even death in severe cases [ 4 ]. And post-ERCP pancreatitis (PEP) is one of the most common adverse events (AEs), and it has the potential to cause morbidity and mortality from clinical complications [ 5 ]. There are many risk factors for PEP, mainly divided into patient-related factors and ERCP procedure-related factors.…”

Aggressive hydration with lactated Ringer’s solution versus plasma solution for the prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (ALPS study): protocol for a multicentre, double-blind, randomised controlled trial

“… 1 2 5 In the USA, where around 700 000 ERCPs are performed every year, the financial burden placed on healthcare by PEP is substantial, with an estimated annual cost of around 200 million dollars. 6 South Korea also bears an economic burden of PEP, with around 50 000 ERCPs performed every year. 7 Assuming an average incidence of PEP of 5%, around 35 000 and 2500 patients are expected to develop PEP in the USA and South Korea, respectively, requiring additional healthcare expenditure.…”

Feasibility and safety of choledochotomy primary closure in laparoscopic common bile duct exploration without biliary drainage: a retrospective study

“…In high-risk patients, the morbidity rate can reach 15%, and the mortality rate is 0.7%, resulting in high medical expenses. According to data from the United States, the average annual cost for treating PEP is estimated to reach 200 million US dollars 8 .…”