Overview of ERCP Complications: Prevention and Management

Guda, Nalini M.; Freeman, Martin L.

doi:10.1007/978-1-4939-2320-5_3

Cited by 6 publications

(14 citation statements)

References 49 publications

(66 reference statements)

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“…ERCP, a comparatively more complicated integral therapeutic modality among endoscopic techniques, is clinically the most common and specialized procedure used for the diagnosis and treatment of pancreatic and biliary system disorders[3-8]. Although it is superior to the traditional operation due to limited trauma, simplicity of the operation, and short recovery time in the treatment and diagnosis of duodenal and pancreatobiliary disorders[5,6], diagnostic and therapeutic ERCP can cause various complications such as pancreatitis, cholangitis, perforation, hemorrhage (especially postsphincterotomy), cholecystitis, cardiopulmonary depression, asymptomatic hyperamylasemia, aspiration, hypoxia, bleeding, sepsis, adverse medication reactions, and death[9-16].…”

Section: Introductionmentioning

confidence: 99%

“…PEP is the most common complication of ERCP,[9,17-19] and itis a crucial factor in morbidity and mortality[20-25]. Chemical, mechanical, enzymatic, hydrostatic and thermal causes are considered as the pathophysiology of the PEP[22].…”

Section: Introductionmentioning

confidence: 99%

“…The incidence rates of PEP have been reported vary from less than 1% up to 40%, because of its dependence on patient factors, procedures, study definitions and methodology[9,23,26-30]. Incidence rates of the severe pancreatitis after ERCP changes between 0.1% and 0.5%[10,27,31-34].…”

Section: Introductionmentioning

confidence: 99%

“…The standardized consensus definitions for PEP in the literature[3,9,28,41-43] were introduced by Cotton, Lehman[44] and Banks, Bollen[45]. The standard definition proposed by Cotton, Lehman[44] is as follows: “Pancreatitis after ERCP is a clinical illness with typical pain, associated with at least a threefold increase in serum amylase (or lipase) at 24 h, with symptoms impressive enough to require admission to hospital for treatment (or extension of an existing or planned admission).”The Atlanta criteria-based definition of PEP proposed by Banks, Bollen[45] is as follows: “The diagnosis of acute pancreatitis requires two of the following three features: (1) Abdominal pain consistent with acute pancreatitis (acute onset of a persistent, severe, epigastric pain often radiating to the back); (2) Serum lipase activity (or amylase activity) at least three times greater than the upper limit of normal; and (3) Characteristic findings of acute pancreatitis on contrast-enhanced computed tomography (CECT) and less commonly magnetic resonance imaging (MRI) or transabdominal ultrasonography.”…”

Section: Introductionmentioning

confidence: 99%

“…Research on the prevention of PEP has identified various approaches to reduce the occurrence and probability of PEP. Based on this research, three different strategies for prevention of the PEP including patient related, procedure related and pharmacological approaches were developed[3,9,30,35,46].…”

Section: Introductionmentioning

confidence: 99%

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Post-endoscopic retrograde cholangiopancreatography pancreatitis: A systematic review for prevention and treatment

Pekgöz

2019

WJG

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BACKGROUND Post endoscopic retrograde cholangiopancreatography (ERCP) is comparatively complex application. Researchers has been investigated prevention of post-ERCP pancreatitis (PEP), since it has been considered to be the most common complication of ERCP. Although ERCP can lead various complications, it can also be avoided. AIMS To study the published evidence and systematically review the literature on the prevention and treatment for PEP. METHODS A systematic literature review on the prevention of PEP was conducted using the electronic databases of ISI Web of Science, PubMed and Cochrane Library for relevant articles. The electronic search for the review was performed by using the search terms “Post endoscopic retrograde cholangiopancreatography pancreatitis” AND “prevention” through different criteria. The search was restricted to randomized controlled trials (RCTs) performed between January 2009 and February 2019. Duplicate studies were detected by using EndNote and deleted by the author. PRISMA checklist and flow diagram were adopted for evaluation and reporting. The reference lists of the selected papers were also scanned to find other relevant studies. RESULTS 726 studies meeting the search criteria and 4 relevant articles found in the edited books about ERCP were identified. Duplicates and irrelevant studies were excluded by screening titles and abstracts and assessing full texts. 54 studies were evaluated for full text review. Prevention methods were categorized into three groups as (1) assessment of patient related factors; (2) pharmacoprevention; and (3) procedural techniques for prevention. Most of studies in the literature showed that young age, female gender, absence of chronic pancreatitis, suspected Sphincter of Oddi dysfunction, recurrent pancreatitis and history of previous PEP played a crucial role in posing high risks for PEP. 37 studies designed to assess the impact of 24 different pharmacologic agents to reduce the development of PEP delivered through various administration methods were reviewed. Nonsteroidal anti-inflammatory drugs are widely used to reduce risks for PEP. Rectal administration of indomethacin immediately prior to or after ERCP in all patients is recommended by European Society for Gastrointestinal Endoscopy guidelines to prevent the development of PEP. The majority of the studies reviewed revealed that rectally administered indomethacin had efficacy to prevent PEP. Results of the other studies on the other pharmacological interventions had both controversial and promising results. Thirteen studies conducted to evaluate the efficacy of 4 distinct procedural techniques to prevent the development of PEP were reviewed. Pancreatic Stent Placement has been frequently used in this sense and has potent and promising benefits in the prevention of PEP. Studies on the other procedural techniques have had inconsistent results. CONCLUSION Prevention of PE...

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Post-endoscopic retrograde cholangiopancreatography pancreatitis: A systematic review for prevention and treatment

Pekgöz

2019

WJG

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Miscellany Complications of ERCP

Paolo

Germani

Alessandra

et al. 2020

Endotherapy in Biliopancreatic Diseases: ERCP Meets EUS

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Emergency Endoscopic Retrograde Cholangiopancreatography Did Not Increase the Incidence of Postprocedural Pancreatitis Compared With Elective Cases

et al. 2022

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Objective The aim of this study was to identify the incidence of and risk factors for post–endoscopic retrograde cholangiopancreatography pancreatitis (PEP) after emergency endoscopic retrograde cholangiopancreatography (ERCP). Methods We performed a prospective multicenter observational study of 3914 patients who underwent ERCP. We compared the incidence of PEP after emergency and elective ERCP. Results A total of 3410 patients were enrolled in this study. Post-ERCP pancreatitis occurred in 44 of 800 patients (5.5%) and in 190 of 2418 patients (7.9%) in the emergency and elective groups, respectively. No significant difference was noted between the groups (odds ratio [OR], 0.73; 95% confidence interval [CI], 0.52–1.03; P = 0.07). Multivariate analysis showed that the following factors increased the risk for PEP after emergency ERCP: contrast medium injection into the pancreatic duct (OR, 2.56; 95% CI, 1.30–5.03; P = 0.005), >4 cannulation attempts (OR, 5.72; 95% CI, 2.61–12.50; P < 0.001), and endoscopic papillary balloon dilatation (OR, 9.24; 95% CI, 2.13–40.10; P < 0.001). Conclusions No significant difference was noted in the incidence of PEP in patients after emergency and elective ERCP. We may prevent PEP even after emergency ERCP by avoiding contrast injection into the pancreatic duct, multiple cannulation attempts, and endoscopic papillary balloon dilatation.

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Overview of ERCP Complications: Prevention and Management

Cited by 6 publications

References 49 publications

Post-endoscopic retrograde cholangiopancreatography pancreatitis: A systematic review for prevention and treatment

Post-endoscopic retrograde cholangiopancreatography pancreatitis: A systematic review for prevention and treatment

Miscellany Complications of ERCP

Emergency Endoscopic Retrograde Cholangiopancreatography Did Not Increase the Incidence of Postprocedural Pancreatitis Compared With Elective Cases

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