Copyright ©2010 Baishideng.
World J Gastrointest Endosc. May 16, 2010; 2(5): 165-178
Published online May 16, 2010. doi: 10.4253/wjge.v2.i5.165
Table 1 Clinical trials evaluating the incidence of overall complications and post-ERCP pancreatitis
AuthorCountryYear publishednNo. ERCPOverall complications (%)Post-ERCP pancreatitis (%)
Large prospective trials
Williams[24]United Kingdom2007456152345.001.60
Cheng 2006 and Sherman 2003b[111,154]United States20061115NRaNRa15.10
Vandervoort[10]United States20021223122311.207.20
Freeman[58]United States2001NRa1963NRa6.70
Deans[11]United Kingdom199795810002.401.00
Johnson[28]United States19971979NRaNRa 10.40
Freeman[29]United States and Canada19962347NRa9.805.40
Large retrospective trials
Cotton[29]United States200911497NRa4.002.60
Lukens[30]United States2009260639243.120.97
Cheon[60]United States2007987214331NRa4.00
Table 2 Patient and procedural risk factors associated with post-ERCP pancreatitis
Patient related factors
Female sex
Young age
History of or suspected sphincter of oddi dysfunction
History of pancreatitis, recurrent pancreatitis or post-ERCP pancreatitis
Procedure related factors
Difficult or multiple cannulation attempts
Multiple pancreatic contrast injections
Pancreatic acinarization
Precut sphincterotomy
Endoscopic papillary balloon dilation
Sphincter of oddi manometry
Distal common bile duct diameter ≤ 1 cm
Presence of a pancreatic stricture
Procedures not involving stone removal
Table 3 Frequency of post-ERCP pancreatitis - conventional contrast based cannulation versus guide-wire cannulation in randomized trials
Rate of pancreatitis
AuthorYear publishedCountrynCC (%)GWC (%)P value
Artifon[70]2007Brazil and United States30016.608.600.037
Lella[69]2004Italy3924.100.00< 0.01
Table 4 Randomized controlled trials evaluating the effect of pancreatic duct stenting on prevention of post-ERCP pancreatitis
AuthorCountryYear publishednRate of post-ERCP pancreatitis
P value
Without stent (%)With stent (%)
Harewood[77]United States20051933.000.000.02
Fazel[85]United States20037428.005.00< 0.05
Tarnasky[18]United States19988026.007.000.03
Smithline[87]United States19939318.0014.000.299
Table 5 Frequency of post-ERCP pancreatitis - endoscopic sphincterotomy vs endoscopic papillary balloon dilation in randomized studies
AuthorYear publishedCountrynRate of pancreatitis
P value
ES (%)EPBD (%)
DiSario[98]b2004United States2370.8315.38< 0.05
Fujita[87]2003Japan2822.8010.90< 0.05
Vlavianos[92]2003United Kingdom2021.014.86NRa
Bergman[99]1997The Netherlands2026.936.93NRa
Table 6 Pharmacologic agents evaluated for potential reduction/prevention of post-ERCP pancreatitis
Pharmacologic agentRCT showed benefit
Glyceryl trinitrateYes
Interleukin-10 (IL-10)Yes
Nafamostat mesylateYes
Anticholinergic drugsNo
Botulinum toxinNo
Fresh frozen plazmaNo
H-2 BlockerNo
N-aceytyl cysteine (NAC)No
Natural beta-caroteneNo
Parenteral nutritionNo
Recombinant PAF acetylhydrolase (rPAF-AH)No
Table 7 Randomized controlled trails of pharmacologic agents evaluated for reduction or prevention of post-ERCP pancreatitis
Rate of post-ERCP pancreatitis (%)
AgentAuthorFactor studiednOverallControlInterventionP value
Martinez–Torres[110]Allopurinol 300 mg PO at 15 h; 300 mg PO at 3 h before ERCP170NRa9.402.300.049
Romagnuolo[111]bAllopurinol 300 mg PO at 1 h before ERCP586NRa4.105.500.440
Katsinelos[112]Allopurinol 600 mg PO at 15 h; 600 mg PO at 3 h before ERCP24310.2017.803.20< 0.001
Mosler[113]Allopurinol 600 mg PO at 4 h; 300 mg PO at 1 h before ERCP34612.5512.1412.960.520
Budzynska[114]Allopurinol 200 mg PO at 15 h; 200 mg PO at 3 h before ERCP30010.707.9012.100.320
Lavy[115]Natural beta-carotene 2 g at 12 h before ERCP3219.609.6010.00NRa
Botulinum toxin
Gorelick[116]Botulinum toxin injection after biliary sphincterotomy26NRa43.0025.000.340
Raty[117]Cephtazidime 2g IV 30 min before ERCP321NRa9.382.580.009
Kwanngern[118]Hydrocortisone 100 mg IV at 1 h before ERCP1206.6711.861.640.031
Manolakopoulos[119]bHydrocortisone 100 mg IV at 30 min before ERCP34010.0013.007.100.380
De Palma[31]Hydrocortisone 100 mg IV immediately before ERCP5295.304.905.70NS
Sherman[120]bPrednisone 40 mg PO at 15 h and at 3 h before ERCP111515.0713.6016.600.190
Budzynska[114]Prednisone 40 mg at 15 h; 40 mg at 3 h before ERCP10.707.9012.000.330
Dumot[43]Methylprednisolone 125 mg IV immediately before ERCP286NRa8.7012.400.340
Barkay[42]Unfractionated heparin 5000 IU SC 20-30 min before ERCP106NRa7.407.80NS
Rabenstein[121]Low molecular weight heparin Certoparin 3000 IU SC the day before ERCP4488.508.818.140.870
Sherman[56]bIL-10 8 μg/kg IV 15-30 min before ERCP30517.3814.3015.400.830
IL-10 20 μg/kg IV 15-30 min before ERCP22.000.140
Deviere[14]IL-10 4 μg/kg IV 30 min before ERCP14429.9024.4010.410.046
IL-10 20 μg/kg IV 30 min before ERCP6.810.017
Dumot[55]IL-10 8 μg/kg IV 15 min before ERCP20010.009.1010.900.650
N-acetyl cystine
Milewski[122]NAC 600 mg IV BID × 2 d after ERCP1069.4311.767.27NS
Katsinelos[123]NAC 70 mg/kg 2 h before and 35 mg/kg 4 h intervals for 24 h after procedure24910.809.6012.10> 0.500
Prat[124]Nifedipine 20 mg PO 3-6 h before ERCP15515.5017.70 13.20NS
Sand[125]Nifedipine 20 mg PO q 8 h the day of ERCP1663.614.004.00NRa
Hao[126]Glyceryl trinitrate 5 mg IV and 100 mg vitamin C 5 min before ERCP maneuvers7416.2025.007.900.012
Beauchant[127]bNitroglycerin bolus of 0.1 mg, then 35 g/kg/min IV for 6 h after ERCP20812.0015.0010.000.260
Kaffes[128]Transdermal glyceryl trinitrate patch (15 mg) precordial area 30-40 min before ERCP318NRa7.407.70NS
Moreto[129]Transdermal glyceryl trinitrate patch (15 mg) precordial area 30-40 min before ERCP1449.0015.004.000.030
Sudhindran[130]Glyceryl trinitrate 2 mg SL 5 min before ERCP18613.0018.008.00< 0.050
Khoshbaten[131]Diclofenac 100 mg PR immediately after ERCP10015.0026.004.00< 0.010
Cheon[132]Diclofenac 50 mg at 30-90 min before and at 4-6 h after ERCP20716.4016.7016.20NS
Murray[44]Diclofenac 100 mg PR immediately after ERCP22011.0015.456.360.049
Sotoudehmanesh[133]Indomethacin 100 mg PR after ERCP4424.986.783.16OR 0.4 (0.2 - 1.1)
Kisli[134]Octreotide 0.1 mg gtt 60 min before ERCP and continued during and after ERCP120NRa11.4915.15NS
Li[135]bOctreotide 0.3 mg gtt 1 h before -6 h after ERCP; then 0.1 mg SC; 12 h later 0.1 mg SC8323.855.262.420.046
Thomopoulos[136]Octreotide 500 μg TID starting 24 h before ERCP20110.898.902.000.03
Testoni[137]bOctreotide 200 μg TID × 24 h before ERCP114NRa14.3012.00NS
Hardt[138]Octreotide 200 μg SC the night before ERCP94NRaNRaNRaNS
Duvnjak[139]Octreotide 0.5 mg SC 60 min before ERCP209NRa9.523.85NS
Arvanitidis[140]Octreotide 0.1 mg SC 30 min before; 8 h and 16 h after ERCP7310.9511.1110.81NS
Tulassay[45]bOctreotide 0.1 mg SC 45 min after ERCP11997.846.005.90NS
Arcidiacono[141]Octreotide 0.1 mg SC 120 and 30 min before; 4 h after ERCP1516.62NRaNRaNS
Baldazzi[142]Octreotide 0.1 mg SC 45 min before; 6 h after ERCP100NRaNRaNRaNRa
Testoni[143]Octreotide 0.2 mg SC before ERCP60NRaNRaNRaNS
Testoni[34]Octreotide 200 μg TID × 3 d before ERCP60NRaNRaNRaNS
Ueki[144]Gabexate 600 mg IV 60-90 min before and 22 h after ERCP682.90NRa2.90NS
Manes[145]bGabexate mesylate 500 mg within 1 h before ERCP6085.609.403.90< 0.01
Gabexate mesylate 500 mg within 1h after ERCP3.40< 0.01
Xiong[146]Gabexate 300 mg IV 30 min before gtt until 4 h after ERCP2006.7010.503.100.04
Fujishiro[151]bGabexate 900 mg/1500 mL gtt for 13 h beginning 1 h before ERCP139NRaNRa4.30NS
Andriulli[59]bGabexate 500 mg 30 min before gtt until 6 h after ERCP11275.604.805.80NS
Masci[96]bGabexate 500 mg IV 30 min before gtt until 6.5 h after ERCP and 1 g IV for 13 h after ERCP4341.802.201.40NS
Andriulli[147]bGabexate 500 mg IV 30 min before and 2 h after ERCP5798.606.508.10NS
Cavallini[148]bGabexate 1 g IV 30-90 min before gtt until 12 h after ERCP4185.
Nafamostat mesylate
Choi[149]Nafamostat mesylate 20 mg gtt 1 h before and for 24 h after ERCP7045.407.403.300.018
Yoo[150]Ulinastatin 100 000 U gtt after ERCP for 5.5 h2276.205.606.700.715
Ueki[144]Ulinastatin 150 000 units 60-90 min before & for 22 h after ERCP682.902.902.90NS
Fujishiro[151]bUlinastatin 150 000 units 1 h before, during; 11 h after ERCP6.50NS
Ulinastatin 50 000 units8.50NS
Tsujino[152]bUlinastatin 150 000 U gtt 10 min before ERCP4065.177.402.900.041
Kapetanos[153]Pentoxifylline 400 mg PO TID before ERCP3204.383.005.600.28
Recombinant PAF acetylhydrolase
Sherman[154]bRecombinant PAF acetylhydrolase (rPAF-AH) 1 mg/kg gtt < 1 h before ERCP60017.6019.6017.500.59
Recombinant PAF acetylhydrolase (rPAF-AH) 5 mg/kg gtt < 1 h before ERCP15.900.34
van Westerloo[155]Semapimod IV 50 mg/100 mL glucose gtt 1 h before ERCP24211.9814.889.090.117
Lee[156]bSomatostatin 3 mg in 500 mL NS gtt 12 h starting 30min before ERCP3916.659.603.600.02
Andriulli[59]bSomatostatin 750 μg IV 30 min before and continued for 6 h after ERCP6.30NS
Arvanitidis[157]Somatastatin 4 μg/kg gtt 12 h on identification of the papilla and before introduction of the catheter372NRa9.801.70< 0.05
Somatostatin 3 mg gtt 12 h on identification of the papilla and before introduction of the catheter1.70< 0.05
Poon[158]Somatostatin 250 mg IV bolus immediately after ERCP270NRa13.304.400.01
Andriulli[147]bSomatastatin 750 μg IV 30 min before and 2 h after ERCP11.50NS
Poon[159]Somatostatin 3 mg in 500 mL NS gtt for 12 h starting 30 min before ERCP2205.9110.003.000.03
Bordas[160]Natural somatostatin 4 mg/kg IV on identification of the papilla and before introduction of the catheter160NRa10.002.50< 0.05
Topical spray on papilla
Matsushita[15]Epinephrine (10 mL of 0.02%) sprayed on papilla before cannulation3701.
Schwartz[161]Lidocaine (10 mL of 1%) sprayed on the major papilla before cannulation2944.083.044.320.73