Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis: An Updated Review of Current Preventive Strategies

Abstract

Pancreatitis is a serious complication of endoscopic retrograde cholangiopancreatography, with incidence rates as high as 16% in some centers. Recent studies have also shown an upward trend in hospitalization due to endoscopic retrograde cholangiopancreatography-related pancreatitis. Early interventions taken before, during, and after the procedure can significantly reduce the risk of pancreatitis and decrease morbidity and mortality of the patients. To select appropriate patients for endoscopic retrograde cholangiopancreatography, in-depth knowledge of the patient-related and procedure-related risk factors is required. This updated clinical review outlines various pharmacological agents and surgical methods used for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis. Current evidence supports the use of rectal non-steroidal anti-inflammatory drugs and pancreatic stent placement as an effective preventive strategy. Further research is needed to compare these preventive modalities to improve patient outcomes after endoscopic retrograde cholangiopancreatography.

Pancreatite pós-colangiopancreatografia retrógrada endoscópica: uma revisão narrativa

“…Estudos demonstram que o uso do fio-guia reduz, consideravelmente, a incidência de PPC, em aproximadamente 50%, além da maior taxa de acerto da canulação inicial e menor Brazilian Journal of Development, Curitiba, v.8, n.11, p. 74887-74903, nov., 2022 necessidade de esfincterotomia pré-corte. Mas, existem alguns fios-guia que durante a passagem podem elevar o risco de PPC, pois causam lesão no orifício do ducto de Wirsung (HARSHIL, 2021;BHATT, 2021).…”

“…Além disso, a administração retal de AINEs mostra-se superior à administração oral, por ter maior biodisponibilidade e início de ação mais rápido. Destaca-se, dentre os AINEs, a indometacina e o diclofenaco (BHATT, 2021).…”

Versatile Functions of Somatostatin and Somatostatin Receptors in the Gastrointestinal System

“…SST (0.25mg, and prophylactical SST long-term (0.25mg/h for 10h iv) decreased postendoscopic retrograde cholangiopancreatography (ERCP) pancreatitis and post-ERCP hyperamylasemia (87). However, current effective preventive strategy suggested rectal non-steroidal anti-inflammatory drugs and pancreatic stent placement (88), and a meta-analysis showed SST lacks the benefit in patients with ERCP after short-term infusion, but gains an advantage in single-bolus or long-term injection (89). Therefore, the risk vs benefit of SST and analogues should be carefully assessed in patients (88).…”

“…However, current effective preventive strategy suggested rectal non-steroidal anti-inflammatory drugs and pancreatic stent placement (88), and a meta-analysis showed SST lacks the benefit in patients with ERCP after short-term infusion, but gains an advantage in single-bolus or long-term injection (89). Therefore, the risk vs benefit of SST and analogues should be carefully assessed in patients (88). Long-acting SST analogues (Octreotide, 20mg/m or Lanreotide, 90mg/28 d, 12months, im) decreased blood transfusion in patients with refractory bleeding from gastrointestinal angiodysplasias (90).…”

Risk Factors Associated with Acute Pancreatitis after Percutaneous Biliary Intervention: We Do Not Know Nearly Enough

“…Among these, acute pancreatitis is a relatively common complication with an incidence of approximately 0.9-24.2% [9][10][11][12][13] and seriously affects the prognosis of patients with MBO. Previous studies have investigated the risk factors for acute pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP) [14][15][16][17]. However, the research on the clinical risk factors of acute pancreatitis after percutaneous biliary intervention is limited, and the pathogenesis remains unclear.…”