Prevention of Postendoscopic Retrograde Cholangiopancreatography Pancreatitis: The Endoscopic Technique

Abstract

Pancreatitis is the most frequent and distressing complication of endoscopic retrograde cholangiopancreatography (ERCP). Many recent studies have reported the use of pharmacological agents to reduce post-ERCP pancreatitis (PEP); however, the most effective agents have not been established. Reduction in the incidence of PEP in high-risk patients has been reported through specific cannulation techniques such as guide wire-assisted cannulation and the use of pancreatic stents. The present review focuses on ERCP techniques for the prevention of PEP.

Consenso de indicadores de calidad en la atención en colangiopancreatografía retrógrada endoscópica

“…En estos casos se recomienda el uso de técnicas avanzadas de canulación como la técnica de canulación con doble guía, canulación con ayuda de prótesis pancreática, canulación mediante esfinterotomía transpancreática y canulación con corte para acceso ampular. Los estudios sobre estas técnicas son escasos y con heterogeneidad importante además reportan porcentajes de éxito y complicaciones variables [43][44][45][46]47,48 .…”

Optimal Use of Wire-Assisted Techniques and Precut Sphincterotomy

“…However, prolonged and repeated cannulation procedures prior to precut with inexperienced hands may increase the risk of PEP. Among various techniques, precut fistulotomy reduced the risk of PEP compared with the conventional precut method, and precut following placement of prophylactic PS also reduced the rate of PEP [ 50 - 53 , 61 ]. However, still more comparative studies with transpancreatic septotomy, taking into account the type of devices and criteria such as difficult cannulation, will be needed to clarify the question of complications.…”

Prospective Evaluation of Transpancreatic Sphincterotomy Comparing to Needle-knife Precut in Difficult Biliary Cannulation: Short-and Long-term Outcomes

“…TPS involves the placement of a papillotome in the pancreatic duct and performing sphincterotomy in the direction of the bile duct, then extending the sphincterotomy to cannulate the biliary duct 1,8,9 . ERCP is an invasive procedure with an overall adverse events rate of approximately 4-11%, and the most common one is post-ERCP pancreatitis (PEP) [10][11][12] . Using advanced cannulation techniques in a native papilla is considered a risk factor of PEP, ESGE suggested prophylactic pancreatic stenting in patients receiving TPS to decrease this risk 1,[13][14][15] . Pancreatic duct stricture or chronic pancreatitis could be developed after pancreatic sphincterotomy; therefore, a long follow-up period is needed to track these adverse outcomes.…”