Reducing the risk of post‐endoscopic retrograde cholangiopancreatography pancreatitis

Abstract

Pancreatitis is the most common and potentially devastating complication of endoscopic retrograde cholangiopancreatography (ERCP), resulting in significant morbidity, occasional mortality, and increased health-care expenditure. Accordingly, the prevention of post-ERCP pancreatitis (PEP) remains a major clinical and research priority. Strategies to reduce the incidence of PEP include thoughtful patient selection, appropriate riskstratification, sound procedural technique, prophylactic pancreatic stent placement, and pharmacoprevention. Despite advances in all these areas, however, the incidence of PEP remains as high as 15% in high-risk cases. Thus, additional research towards the goal of eliminating PEP is necessary. Herein is an evidence-based review of strategies to prevent pancreatitis after ERCP, focusing on recent important developments in the field.

Peer Review #3 of "Identification of research trends concerning application of stent implantation in the treatment of pancreatic diseases by quantitative and biclustering analysis: a bibliometric analysis (v0.1)"

“…As a diagnostic tool, it was used to assess the disorders of pancreas [39]. As a most common complication of ERCP, the incidence of PEP is still as high as 15% in high-risk cases [40]. And a small number of patients could develop severe pancreatitis.…”

“…Manuscript to be reviewed 1 Table 5. The cluster analysis of 8 clusters Cluster Number of MeSH terms a Cluster analysis 23,34,56,58,69,72,79,82 Stents placement in pancreatic neoplasms 5,9,10,19,21,24,27,36,39,40,41 The complications of stents placement in bile duct neoplasms and pancreatic neoplasms 8,35,45,49,50,52,54,71,73,74,75,76 postoperative complications after stent placement such as pancreaticoduodenectomy 1,2,3,6,11,15,17,18,46,47,51,60,67,80 Stents for the prevention of pancreatic fistula following pancreaticoduodenectomy 12,13,14,22,28,37,48,61,65 Prophylactic pancreatic duct stent can reduce the incidence of post-ERCP pancreatitis (PEP) 4,…”

Report of the International Symposiums at the 95th Congress of Japan Gastroenterological Endoscopy Society in Tokyo, 2018

“…Early PD stenting might reduce the risk of PEP but should be further evaluated. In addition to the use of guidewire‐assisted cannulation and PD stenting, giving intrarectal nonsteroidal anti‐inflammatory drugs (NSAIDs) and aggressive intravenous fluids are shown to be effective for PEP prevention . Last but not least, Arvanitakis emphasized that the proper indication for ERCP is essential to avoid complications.…”

Reducing the risk of post‐endoscopic retrograde cholangiopancreatography pancreatitis using 4‐Fr pancreatic plastic stents placed with common‐type guidewires: Results from a prospective multinational registry

“…Pancreatic plastic stents (PPS) have been shown to decrease post‐endoscopic retrograde cholangiopancreatography pancreatitis (PEP) in multiple trials and meta‐analyses . This led to various society guidelines to recommend use of stents in select patients .…”

“…P ANCREATIC PLASTIC STENTS (PPS) have been shown to decrease post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) in multiple trials and meta-analyses. [1][2][3][4][5] This led to various society guidelines to recommend use of stents in select patients. 6,7 Patients deemed at higher risk for PEP are of interest.…”