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World J Gastroenterol. Sep 14, 2012; 18(34): 4635-4638
Published online Sep 14, 2012. doi: 10.3748/wjg.v18.i34.4635
Post-endoscopic retrograde cholangio-pancreatography pancreatitis: Is time for a new preventive approach?
Stella Tammaro, Roberta Caruso, Francesco Pallone, Giovanni Monteleone
Stella Tammaro, Division of Gastroenterology, Azienda Ospedaliera Universitaria, 84131 Salerno, Italy
Roberta Caruso, Francesco Pallone, Giovanni Monteleone, Department of Systems Medicine, Division of Gastroenterology, University of Rome Tor Vergata, 00133 Rome, Italy
Author contributions: Tammaro S collected the materials and contributed to writing the manuscript; Caruso R and Monteleone G discussed the topic and contributed to writing the paper; Pallone F supervised the manuscript.
Supported by The Fondazione “Umberto Di Mario” Onlus, Rome
Correspondence to: Giovanni Monteleone, MD, PhD, Department of Systems Medicine, Division of Gastroenterology, University of Rome Tor Vergata, 00133 Rome, Italy. gi.monteleone@med.uniroma2.it
Telephone: +39-6-72596158 Fax: +39-6-72596391
Received: June 6, 2012
Revised: July 17, 2012
Accepted: July 28, 2012
Published online: September 14, 2012
Abstract

Acute pancreatitis is the most common serious complication of endoscopic retrograde cholangio-pancreatography (ERCP) and its incidence may exceed 25% in some high-risk patient subsets. In some patients, pancreatitis may follow a severe course with pancreatic necrosis, multiorgan failure, permanent disability and even death. Hence, approaches which minimize both the incidence and severity of post-ERCP pancreatitis are worth pursuing. Pancreatic stents have been used with some success in the prevention of post-ERCP, while so far pharmacological trials have yielded disappointing results. A recent multicenter, randomized, placebo-controlled, double-blind trial has shown that rectally administered indomethacin is effective in reducing the incidence of post-ERCP pancreatitis, the occurrence of episodes of moderate-to-severe pancreatitis and the length of hospital stay in high-risk patients. These results together with the demonstration that rectal administration of indomethacin is not associated with enhanced risk of bleeding strongly support the use of this drug in the prophylaxis of post-ERCP pancreatitis.

Keywords: Endoscopic retrograde cholangiopancreatography, Post-endoscopic retrograde cholangiopancreatography pancreatitis, Non-steroidal anti-inflammatory drugs, Indomethacin, Pancreatitis prevention