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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 28, 2015; 21(4): 1069-1080
Published online Jan 28, 2015. doi: 10.3748/wjg.v21.i4.1069
Preventing post-endoscopic retrograde cholangiopancreatography pancreatitis: What can be done?
Goran Hauser, Marko Milosevic, Davor Stimac, Enver Zerem, Predrag Jovanović, Ivana Blazevic
Goran Hauser, Davor Stimac, Department of Internal Medicine, Division of Gastroenterology, Clinical Hospital Centre Rijeka, 51000 Rijeka, Croatia
Marko Milosevic, Department of Anaesthesiology, Clinical Hospital Centre Rijeka, 51000 Rijeka, Croatia
Enver Zerem, Predrag Jovanović, Department of Gastroenterology, University Clinical Center Tuzla, Trnovac bb, 75000 Tuzla, Bosnia and Herzegovina
Ivana Blazevic, Center for Emergency Medicine, Clinical Hospital Centre Rijeka, 51000 Rijeka, Croatia
Author contributions: Hauser C contributed with ideas about the concept, writing of the paper and final revision; Milosevic M contributed to the literature search, writing of the paper and final revision of the paper; Stimac D, Zerem E and Jovanovic P contributed with writing of the paper and final revision of the paper; Blazevic I contributed with ideas about the concept, writing of paper and literature search.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Goran Hauser, MD, PhD, Department of Internal Medicine, Division of Gastroenterology, Clinical Hospital Centre Rijeka, Krešimirova 42, 51000 Rijeka, Croatia. goran.hauser@medri.uniri.hr
Telephone: +385-51-658122 Fax: +385-51-658122
Received: July 15, 2014
Peer-review started: July 15, 2014
First decision: August 15, 2014
Revised: September 2, 2014
Accepted: September 29, 2014
Article in press: September 30, 2014
Published online: January 28, 2015
Abstract

Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is the most common complication of endoscopic retrograde cholangiopancreatography. The incidence of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis varies substantially and is reported around 1%-10%, although there are some reports with an incidence of around 30%. Usually, PEP is a mild or moderate pancreatitis, but in some instances it can be severe and fatal. Generally, it is defined as the onset of new pancreatic-type abdominal pain severe enough to require hospital admission or prolonged hospital stay with levels of serum amylase two to three times greater than normal, occurring 24 h after ERCP. Several methods have been adopted for preventing pancreatitis, such as pharmacological or endoscopic approaches. Regarding medical prevention, only non-steroidal anti-inflammatory drugs, namely diclofenac sodium and indomethacin, are recommended, but there are some other drugs which have some potential benefits in reducing the incidence of post-ERCP pancreatitis. Endoscopic preventive measures include cannulation (wire guided) and pancreatic stenting, while the adoption of the early pre-cut technique is still arguable. This review will attempt to present and discuss different ways of preventing post-ERCP pancreatitis.

Keywords: Endoscopic retrograde cholangiopancreatography, Post-endoscopic retrograde cholangiopancreatography pancreatitis, Sphincterotomy

Core tip: Endoscopic retrograde cholangiopancreatography (ERCP) is a widely used procedure for diagnosing and treating diseases of the pancreatobiliary tree. Post-ERCP pancreatitis is the most frequent complication. Prophylactic measures of post-endoscopic pancreatitis include pharmacological and mechanical ERCP related approaches. Prevention is suboptimal and still not widely accepted.