Endoscopic retrograde pancreatography: When should we do it?

Table 1 Frequency of procedure related complications of endoscopic retrograde pancreatography (6.85%) depending of the results of endoscopic retrograde pancreatography[4]

	Mild to moderate	Severe	Death
Pancreatitis	3.07%	0.40%	0.11%
Bleeding	0.95%	0.39%	0.05%
Perforation		0.60%	0.06%
Infection	1.15%	0.28%	0.11%
Total	5.17%	1.67%	0.33%

Table 2 Indication of endoscopic retrograde pancreatography based on the opinion of Hungarian experts

	Indicated	Slightly indicated	Not indicated	Description
Pancreas divisum	83.6%	16.7%	0%	During therapeutic intervention
Acute pancreatitis	16.7%	50%	33.3%	Recurrent "idiopathic" acute pancreatitis
Chronic pancreatitis	83.3%	16.7%	0%	Complicated chronic pancreatitis (MPD stricture, pancreatic duct stones, chronic abdominal pain, obstructive jaundice)
Autoimmune pancreatitis	66.7%	33.3%	0%	Suspicion of autoimmune pancreatitis which has not identified by noninvasive imaging techniques
Pancreatic neoplasia	0%	50%	50%	Suspicion of pancreatic neoplasia with obstructive jaundice
Pancreatic cystic neoplasia	0%	16.7%	83.3%	In case of IPMN ERP associated with high risk of complications Pancreatic cysts and pseudocysts generally do not communicate with the pancreatic duct therefore the ERP cannot identify them
Pancreatic injury	100%	0%	0%	Suspicion of pancreatic ductal injury in stable patients Suspicion of pancreatic fistula Suspicion of fistula formation
Postoperative pancreatic fistula	100%	0%	0%

ERP: Endoscopic pancreatography; MDP: Main pancreatic duct; IPMN: Intraductal papillary mucinous neoplasms.

Table 3 Indication of endoscopic retrograde pancreatography in the case of suprapapillary bile duct stenosis based on the opinion of Hungarian experts

Indicated	Not indicated	Description
50%	50%	ERP may help differentiate between cholangiocarcinoma and pancreatic illnesses