Risk factors for post-ERCP pancreatitis: A prospective, multicenter study

Abstract

Patient-related factors are as important as procedure-related factors in determining risk for post-ERCP pancreatitis. These data emphasize the importance of careful patient selection as well as choice of technique in the avoidance of post-ERCP pancreatitis.

Indomethacin prevents post-ERCP pancreatitis in selected high-risk patients

“…The most common risk factors for this complication are both patient-related and procedure-related: younger age, female gender, prior ERCP-induced pancreatitis, sphincter of Oddi dysfunction, pancreas divisum, difficulty of cannulation, biliary sphincterotomy or pancreatic opacification [3]. Although some randomized clinical trials (RCTs) have shown a potential benefit of gabexate mesilate and somatostatin in preventing post-ERCP pancreatitis, there are few data to recommend the use of these drugs; moreover, they require continuous infusion and are quite expensive [4,5].…”

ERCP Educational Guidelines for Fellows

“…In clinical series, successful cannulation rates of 95% or higher have been consistently achieved by experienced endoscopists (19), and success rates of at least 80% are the goal of training programs in ERCP (20,21), although higher rates of 85% or 90% have been endorsed (22) or recommended (15,23). It has been demonstrated that endoscopists who perform more than two sphincterotomies per week have higher cannulation rates of the biliary tree (24). A study (22) among surgery fellows found that those without previous endoscopic experience required 148 cases to reach an 85% success rate for cannulation.…”

“…Complication rates ERCP is generally regarded as one of the most complicated of endoscopic procedures, with morbidity and mortality rates of 5% to 10% and 0.1% to 1%, respectively (5,24). Recently, some studies (27)(28)(29) have suggested that morbidity can be minimized by the appropriate use of ERCP performed by skilled advanced endoscopists, in appropriate patients, using adapted equipment.…”

“…Patient selection and physician experience (24,33) are critical aspects in minimizing complications and maximizing procedural success. Patient factors associated with a greater risk of pancreatitis include a history of post-ERCP pancreatitis, female sex, suspected sphincter of Oddi dysfunction and the absence of chronic pancreatitis (24,33).…”

Editorial: Guidewire Trauma: A Key Component of Post-ERCP Pancreatitis That Is Best Controlled by the Endoscopist

“…However, safety still remains a major concern. Various prospective series have reported short term complication rates of 5-10% ( 3,4 ), with post-ERCP pancreatitis (PEP) reported to occur in 2-10% of unselected cases, and in as many as 40% of very high-risk patients ( 5 ). Once considered unpredictable, post-ERCP pancreatitis has been extensively investigated.…”