Published online Oct 16, 2018. doi: 10.4253/wjge.v10.i10.259
Peer-review started: May 18, 2018
First decision: June 4, 2018
Revised: June 10, 2018
Accepted: August 1, 2018
Article in press: August 1, 2018
Published online: October 16, 2018
Acute pancreatitis (AP) is common gastrointestinal disease of varied aetiology. The most common cause of AP is gallstones, followed by alcohol abuse as an independent risk factor. With the increased need for invasive techniques to treat pancreatic and bile duct pathologies such as endoscopic retrograde cholangiopancreatography (ERCP), AP has emerged as the most frequent complication. While severe AP following ERCP is rare (0.5%), if it does develop it has a greater severity index compared to non-ERCP AP. Development of a mild form of AP after ERCP is not considered a clinically relevant condition. Differences in the clinical presentation and prognosis of the mild and severe forms have been found between non-ERCP AP and post-endoscopic pancreatitis (PEP). It has been proposed that AP and PEP may also have different immunological responses to the initial injury. In this review, we summarise the literature on clinical and inflammatory processes in PEP vs non-ERCP AP.
Core tip: Acute pancreatitis (AP) is the most frequent complication after endoscopic retrograde cholangiopancreatography (ERCP) and although low prevalence is found, if it develops it has greater severity index compared to non-ERCP AP. The differences in factors influencing appearance, clinical presentation and prognosis of ERCP induced and non ERCP induced AP were found, lead to opinion that mechanism by which they induce inflammation, may also be different. It would be of great importance to find immunological components that can distinguish patients with tendency to develop severe AP from patients with mild form, especially in ERCP induced AP where organ failure occurs half time earlier.