In contrast, trainee participation has been shown to be a significant risk factor for the development of post-ERCP pancreatitis [ 6 ]. Herein is an evidence-based review of approaches to prevent pancreatitis after ERCP, as well as an overview of pressing research questions in this important area.
However, since the study by Baron and Harewood [ 44 ], a number of studies have demonstrated that balloon dilation following sphincterotomy can be used effectively and safely to extract bile duct stones.
Studies without treatment allocation blinding are often biased in favor of the intervention and exaggerate perceived effects. First, predictors of PEP appear synergistic in nature Does glyceryl nitrate prevent post-ERCP pancreatitis?
Balloon sphincteroplasty for removing difficult bile duct stones. Several other agents including heparin, interleukin, allopurinol, phosphodiesterase-5 inhibitor and N-acetylcysteine, have not shown any benefit in reducing the risk of PEP [ 60 - 64 ].
Gastrointest Endosc 79 4: Does leaving a main pancreatic duct stent in place reduce the incidence of precut biliary sphincterotomy ES -induced pancreatitis? Epinephrine Epinephrine sprayed directly upon the papilla at the time of ERCP has been postulated to prevent PEP through direct relaxation of the SO and reduction of papillary edema by decreasing capillary permeability Two multicenter randomized trials testing this theory are underway in the Midwestern United States and the Netherlands.
Risk factors for post-ERCP pancreatitis: Pancreatic stent placement PSP is therefore thought to reduce the risk of PEP by relieving pancreatic ductal hypertension that develops as a result of transient procedure-induced stenosis of the pancreatic orifice.
Octreotide is a synthetic analogue with a longer half-life than somatostatin. J Gastroenterol 45 8: The role of endoscopy in the evaluation of suspected choledocholithiasis.
A prospective, randomized, placebo-controlled trial of transdermal glyceryl trinitrate in ERCP: Increased levels of stress and burnout are related to decreased physician experience and to interventional gastroenterology career choice: It is most easily administered either by sublingual spray or transdermal patch.
Most experts agree that the intra-pancreatic tip of the stent should not rest at the pancreatic genu or in a side-branch 55however whether short stents ending in the pancreatic head or longer stents ending in the body or tail are preferable is unknown, and comparative effectiveness studies in this area are needed.
Endoscopic Sphincterotomy Thermal injury following application of electrosurgical current during biliary or pancreatic sphincterotomy has been implicated in the pathogenesis of post-ERCP pancreatitis [ 737 ].
Endoscopist procedure volume is suggested to be a risk factor for PEP, although multi-center studies have not confirmed this trend, presumably because low-volume endoscopists tend to perform lower-risk cases 56, 58, 85, A principal objective of an upcoming large-scale comparative effectiveness trial of indomethacin and prophylactic stent placement is to develop a robust repository of biological specimens from study participants to drive translational research elucidating the pathophysiology of PEP and pancreatitis in general.
Additional studies that include a control group are necessary to fully evaluate PSP for this indication. Association of greater intravenous volume infusion with shorter hospitalization for patients with post-ERCP pancreatitis.
Bedside scoring system to predict the risk of developing pancreatitis following ERCP.
Gastrointest Endosc 69 4: Preventive strategies can be broadly divided into 5 areas: However, it should be used judiciously, and alternate imaging modalities such as EUS and MRCP should be considered in diagnostic cases.
Further studies are needed to help define the exact point at which the risk-benefit ratio favors precut sphincterotomy over repeated cannulation attempts, although the natural tendency to continue standard cannulation attempts beyond minutes should be controlled, and alternative strategies should be attempted early in a difficult case.Pancreatitis is the most common complication of ERCP.
It can be associated with substantial morbidity.
Hence, the minimization of both the incidence and severity of post-ERCP pancreatitis is paramount. hypothesis that transdermal glyceryl trinitrate could be effective in the prevention of post-ERCP pancreatitis.
Methods: One hundred forty-four patients undergoing ERCP were randomized: 71 received a mg glyceryl trinitrate patch (glyceryl trinitrate group) and 73 a placebo patch (control group).
Recent studies have had a major impact on both procedural techniques and pharmacological methods for prophylaxis of post-ERCP pancreatitis.
The purpose of this article is to review the relevant literature and describe the most recent and effective approaches in prevention and. Methods In this multicenter, randomized, placebo-controlled, double-blind clinical trial, we assigned patients at elevated risk for post-ERCP pancreatitis to receive a single dose of rectal.
impact on both procedural techniques and pharmacological methods for prophylaxis of post-ERCP pancreatitis. The purpose of this article is to review the relevant literature and describe the most recent and effective approaches in prevention and management of post-ERCP.
Pharmacological Prevention for Post-ERCP Pancreatitis: Since the introduction of ERCP, numerous pharmacologic drugs have been assessed to prevent post-ERCP pancreatitis based on their pharmacologic mechanism and their effect on one or more of the factors associated with pancreatic damage (Figure 1) .Download