Successes/Failures of post ERCP pancreatitis.

[Guest guest]

Early successes and late failures in the prevention of post endoscopic

retrograde cholangiopancreatography pancreatitis.

World J Gastroenterol 2007 July

Lieb II JG, Draganov PV.

Acute pancreatitis is the most common complication of endoscopic

retrograde cholangiopancreatography (ERCP). The only way to prevent

this complication is to avoid an ERCP all together. Because of the

risks involved, a careful consideration should be given to the

indication for ERCP and the potential risk/benefit ratio of the test.

Once a decision to perform an ERCP is made, the procedure should be

carried out with meticulous care by an experienced endoscopist, and

with a minimum of pancreatic duct opacification. Several pharmacologic

agents have been tested, but to date the most important method of

reducing post ERCP pancreatitis is the placement of pancreatic stent.

Pancreatic stents should be placed in all patients at high risk of

this complication such as those undergoing pancreatic sphincterotomy,

pancreatic duct manipulation and intervention, and patients with

suspected sphincter of Oddi dysfunction. Pancreatic stents should be

also considered in patients requiring precut sphincterotomy to gain

biliary access.