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Copyright ©2007 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 14, 2007; 13(26): 3567-3574
Published online Jul 14, 2007. doi: 10.3748/wjg.v13.i26.3567
Early successes and late failures in the prevention of post endoscopic retrograde cholangiopancreatography
John G Lieb II, Peter V Draganov
John G Lieb II, Gastroenterology Fellow, Division of Gastroen-terology, Department of Internal Medicine, University of Florida, FL 32610-0214, United States
Peter V Draganov, Associate Professor of Medicine, Division of Gastroenterology, University of Florida, FL 32610-0214, United States
Author contributions: All authors contributed equally to the work.
Correspondence to: Peter V Draganov, MD, Division of Gastroenterology, 1600 SW Archer Rd, Gainesville, FL 32610- 0214, United States. dragapv@medicine.ufl.edu
Telephone: +1-352-3765289 Fax: +1-352-3923618
Received: April 29, 2007
Revised: April 30, 2007
Accepted: May 22, 2007
Published online: July 14, 2007
Abstract

Acute pancreatitis is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP). The only way to prevent this complication is to avoid an ERCP all together. Because of the risks involved, a careful consideration should be given to the indication for ERCP and the potential risk/benefit ratio of the test. Once a decision to perform an ERCP is made, the procedure should be carried out with meticulous care by an experienced endoscopist, and with a minimum of pancreatic duct opacification. Several pharmacologic agents have been tested, but to date the most important method of reducing post ERCP pancreatitis is the placement of pancreatic stent. Pancreatic stents should be placed in all patients at high risk of this complication such as those undergoing pancreatic sphincterotomy, pancreatic duct manipulation and intervention, and patients with suspected sphincter of Oddi dysfunction. Pancreatic stents should be also considered in patients requiring precut sphincterotomy to gain biliary access.

Keywords: Post endoscopic retrograde cholangiopancreatography pancreatitis; Somatostatin; Gabexate; IL-10; Pancreatic stents; Aspirating catheter; Sphincter of Oddi dysfunction