Prophecy about post-endoscopic retrograde cholangiopancreatography pancreatitis: From divination to science

Table 3 Clinical pearls to help avoid post-endoscopic retrograde cholangiopancreatography pancreatitis

Remember that ERCP is the most dangerous endoscopic procedure that can be associated with bad outcomes

Instead of diagnostic ERCP, use alternative imaging techniques such as magnetic resonance cholangiopancreatography or EUS, especially in high-risk patients

Rectal NSAIDs before or after ERCP procedure can be a simple measure to prevent PEP

Tailor a variety of cannulation techniques to the individual risk profile and the papillary anatomy of the patient

In cases of difficult cannulation, early precut or fistulotomy technique with a pancreatic stent (performed by an expert endoscopist) can decrease the risk of PEP

Quit the ERCP procedure earlier in high-risk patients if success is not achieved quickly. After a failed ERCP, alternative therapeutic methods such as percutaneous or EUS-guided approaches can be considered

In high risk patients, make sure that a prophylactic pancreatic stent is placed. In cases with equivocal risk at the end of the procedure, a prophylactic pancreatic stent can eliminate the fear of PEP

ERCP: Endoscopic retrograde cholangiopancreatography; PEP: Post-endoscopic retrograde cholangiopancreatography pancreatitis; EUS: Endoscopic ultrasonography; NSAIDs: Non-steroidal anti-inflammatory drugs.