Post-ERCP pancreatitis: Pathophysiology, early identification and risk stratification

Abstract

Acute pancreatitis is the most common and feared complication of endoscopic retrograde cholangiopancreatography (ERCP). The aim of the study was to review the current knowledge on the nomenclature, etiology, pathophysiology, clinical presentation, diagnostic workup, and risk stratification of post-ERCP pancreatitis (PEP). A structured search in PubMed and Scopus databases was performed using search terms related to the subject of diagnosis, pathophysiology, risk stratification of post-ERCP pancreatitis, including full text articles and abstracts in the English language. Several causes, operating both at a local and systemic level, might play an important role in the pathogenesis of PEP. Different patient-related risk factors can help predict post-ERCP pancreatitis; diagnosis depends on clinical presentation, imaging and laboratory investigations. As an outpatient procedure, post-ERCP pancreatitis may be safe in a selected group of low-risk patients. Further investigation of the etio-pathogenesis of post-ERCP pancreatitis is required in order to improve diagnosis and treatment. Early identification and severity stratification of post-ERCP pancreatitis greatly affects the patient's outcome. There is still controversy concerning the risk factors related to PEP. More studies are needed to clarify early and definite diagnosis, risk and severity stratification, as well as treatment of post-ERCP pancreatitis.

Postendoscopic retrograde cholangiopancreatography pancreatitis

“…8 The average incidence of PEP was 3% to 10%. 1,4,[7][8][9] In ERCP for high-risk patients, more risk factors of the patient would cause higher incidence of PEP. 10…”

“…According to a recent meta‐analysis from 108 randomized controlled trials (RCTs) with 13 296 patients, the overall incidence of PEP was 9.7% and the incidence was 14.7% in 2345 high‐risk patients . A systematic survey of prospective studies in 2007 involving 16 855 patients demonstrated the incidence of PEP was 3.47% . The average incidence of PEP was 3% to 10% .…”

“…A systematic survey of prospective studies in 2007 involving 16 855 patients demonstrated the incidence of PEP was 3.47% . The average incidence of PEP was 3% to 10% . In ERCP for high‐risk patients, more risk factors of the patient would cause higher incidence of PEP …”

“…It would obstacle the flow of pancreatic secretion because of sphincter of Oddi edema and determine the acute pancreatic inflammation. Another common etiology is hydrostatic injury from contrast media …”

“…Another common etiology is hydrostatic injury from contrast media. 8 Some researches noticed intestinal enzymes refluxed into the pancreatic duct by ERCP maneuver might be a possible cause of PEP. 11 Bacteria from a contaminated endoscope causing the ductal injury and subsequent pancreatitis is a probable cause.…”