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World J Gastrointest Endosc. May 16, 2010; 2(5): 165-178
Published online May 16, 2010. doi: 10.4253/wjge.v2.i5.165
Endoscopic retrograde cholangiopancreatography associated pancreatitis: A 15-year review
Kevin E Woods, Field F Willingham
Kevin E Woods, Department of Medicine, Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States
Field F Willingham, Department of Medicine, Division of Gastroenterology, Emory University School of Medicine, Atlanta, GA 30322, United States
Author contributions: Woods KE and Willingham FF performed the analysis and synthesis of the literature and wrote and approved the final version.
Correspondence to: Field F Willingham, MD, MPH, Director of Endoscopy, Emory University School of Medicine, 1365 Clifton Road, NE, Building B STE 1200, Atlanta, GA 30322, United States.
Telephone: +1-404-7783184 Fax:-+1-404-7782925
Received: January 15, 2010
Revised: April 29, 2010
Accepted: May 6, 2010
Published online: May 16, 2010

The aim of this article is to review the literature regarding post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. We searched for and evaluated all articles describing the diagnosis, epidemiology, pathophysiology, morbidity, mortality and prevention of post-ERCP pancreatitis (PEP) in adult patients using the PubMed database. Search terms included endoscopic retrograde cholangiopancreatography, pancreatitis, ampulla of vater, endoscopic sphincterotomy, balloon dilatation, cholangiography, adverse events, standards and utilization. We limited our review of articles to those published between January 1, 1994 and August 15, 2009 regarding human adults and written in the English language. Publications from the reference sections were reviewed and included if they were salient and fell into the time period of interest. Between the dates queried, seventeen large (> 500 patients) prospective and four large retrospective trials were conducted. PEP occurred in 1%-15% in the prospective trials and in 1%-4% in the retrospective trials. PEP was also reduced with pancreatic duct stent placement and outcomes were improved with endoscopic sphincterotomy compared to balloon sphincter dilation in the setting of choledocholithiasis. Approximately 34 pharmacologic agents have been evaluated for the prevention of PEP over the last fifteen years in 63 trials. Although 22 of 63 trials published during our period of review suggested a reduction in PEP, no pharmacologic therapy has been widely accepted in clinical use in decreasing the development of PEP. In conclusion, PEP is a well-recognized complication of ERCP. Medical treatment for prevention has been disappointing. Proper patient selection and pancreatic duct stenting have been shown to reduce the complication rate in randomized clinical trials.

Keywords: Cholangiopancreatography endoscopic retrograde, Adverse effects, Pancreatitis, Prevention and control/therapy, Risk assessment, Risk factors, Ampulla of vater, Sphincter of oddi, Humans