Best practices for prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis

Figure 1 Flow chart illustrating the best-practice approach to post-endoscopic retrograde cholangiopancreatography pancreatitis prevention and management. Notably, in patients with complications of underlying advanced liver disease and/or comorbidities such as portal hypertension, coagulopathy, renal dysfunction, and volume overload, the selection of these prophylactic options should be made on a case-by-case basis and, when available, based on clinical evidence. ¹Younger age, female sex, normal bilirubin, recurrent pancreatitis, prior post endoscopic retrograde cholangiopancreatography pancreatitis, sphincter of Oddi dysfunction; ²Rectal indomethacin or diclofenac; ³Lactated Ringers preferred, 35-45 mL/kg administered over 8-10 h. PEP: Post endoscopic retrograde cholangiopancreatography pancreatitis; NSAID: Non-steroidal anti-inflammatory drug.