Pathophysiology Our understanding of the mechanisms underlying PEP has evolved slowly and remains limited. Several other techniques have been implicated as independent risk factors for PEP.
Much more favorable results have been recently reported with the use of non-steroidal anti-inflammatory drugs NSAIDs. The relative contribution of each of the aforementioned injurious factors remains unclear and is probably variable, but no single factor appears dominant.
First, the true magnitude of benefit of PSP remains unclear as none of the randomized controlled trials evaluating this intervention were blinded in nature. The rates of post-ERCP pancreatitis were significantly lower in patients who were administered indomethacin vs placebo 9.
Surg Endosc 23 8: World J Gastroenterol 14 Prospective, randomized, controlled trial of prophylactic pancreatic stent placement for endoscopic snare excision of the duodenal ampulla. A new method of achieving deep cannulation of the common bile duct during endoscopic retrograde cholangiopancreatography.
Rectally administered indomethacin should be considered if any risk factor for PEP is present. Guide wire-assisted cannulation for the prevention of post-ERCP pancreatitis: Of note, is that balloon dilation after biliary sphincterotomy to facilitate large stone extraction does not appear to increase the risk of PEP 69, There have been no confirmatory studies on the use of antibiotics.
It is important to keep in mind that the demonstrated benefits of PSP must be weighed against several potential disadvantages.
Improved stent characteristics for prophylaxis of post-ERCP pancreatitis. N Engl J Med ; Moreover, this process limits the likelihood of an inadvertent pancreatic or intramural papillary injection.
There are no comparative effectiveness data evaluating the effect of various guidewires on the risk of pancreatitis Prophylactic effect of glyceryl trinitrate on post-endoscopic retrograde cholangiopancreatography pancreatitis: Octreotide versus hydrocortisone versus placebo in the prevention of post-ERCP pancreatitis: Strategies to reduce the incidence of PEP, which should be considered in every case, include thoughtful patient selection, risk-stratification, sound procedural technique, prophylactic pancreatic stent placement, and pharmacoprevention.
Am J Gastroenterol 94 2: Pancreatic-stent placement for prevention of post-ERCP pancreatitis: Can wire-guided cannulation prevent post-ERCP pancreatitis.
Risk factors for post-ERCP pancreatitis: Pancreas stenting A in high risk cases and wire guided approaches B are technical manoeuvres which minimize the risk of PEP.
Early manometry was performed using continuous perfusion compared with more recent manometry which involves continuous aspiration of the perfused fluid, in theory reducing the risk of perfusion-related hydrostatic ductal injury.
The patient-related factors included suspected sphincter of Oddi dysfunction relative risk RR 4.
Journal of clinical gastroenterology 45 2: Chemical injury may result following injection of contrast medium into the pancreatic duct. Faster rate of initial fluid resuscitation in severe acute pancreatitis diminishes in-hospital mortality.
A randomized controlled multi-center study of patients comparing stone extraction after sphincterotomy compared to dilation of a native papilla showed that pancreatitis occurred significantly more often in the dilation group With this in mind, Yoo et al.
A prospective randomized study. Eur J Med Res Contrast injection through the catheter can also facilitate deep cannulation of the common bile duct. Amylase and lipase elevations often occur after ERCP even in asymptomatic patients [ 7 ].
Because IVF administration can be dangerous in older persons or in those with sodium retaining states and the volume of infusion at which the risk-benefit ratio of IVF is optimized remains unknown, additional research is necessary to establish an evidence-based approach.
While large-scale studies might provide additional insight, at this time, using these agents to reduce the risk of post-ERCP pancreatitis is not recommended. Endoscopist procedure volume is suggested to be a risk factor for PEP, although multi-center studies have not confirmed this trend, presumably because low-volume endoscopists tend to perform lower-risk cases 56, 58, 85, Prophylaxis of post-ERCP pancreatitis: Does prophylactic administration of corticosteroid reduce the risk and severity of post-ERCP pancreatitis: However, this continues to be an active area of research.
Pharmacological Prevention for Post-ERCP Pancreatitis: Since the introduction of ERCP, numerous pharmacologic drugs have been assessed to prevent post-ERCP pancreatitis based on their pharmacologic mechanism and their effect on one or more of the factors associated with pancreatic damage (Figure 1) .
Recent studies have had a major impact on both procedural techniques and pharmacological methods for prophylaxis of post-ERCP pancreatitis. The purpose of this article is to review the relevant literature and describe the most recent and effective approaches in prevention and.
Recent studies have had a major impact on both procedural techniques and pharmacological methods for prophylaxis of post-ERCP pancreatitis.
The purpose of this article is to review the relevant literature and describe the most recent and effective approaches in prevention and. Methods In this multicenter, randomized, placebo-controlled, double-blind clinical trial, we assigned patients at elevated risk for post-ERCP pancreatitis to receive a single dose of rectal.
Post-ERCP pancreatitis is defined as acute pancreatitis that has developed de novo following ERCP and, based on consensus guidelines proposed by Cotton et al.
inis the presence of new pancreatic-type abdominal pain associated with at least a threefold increase in serum amylase concentration occurring 24 hours after an ERCP, with pain.
AW A large multicenter, randomized, noninferiority trial, funded by the National Institutes of Health, is currently underway to explore the use of rectal indomethacin alone compared to indomethacin and pancreatic duct stenting for the prevention of post-ERCP pancreatitis in high-risk patients.
The results from this study will likely be of great importance, but the study is still a few years away from concluding.Methods for prevention of post ercp pancreatitis