Acute pancreatitis remains the most common complication of endoscopic retrograde cholangiopancreatography (ERCP). It is reported to occur in 2-10% of unselected patient samples and up to 40% of high-risk patients. The purpose of this article is to review the evidence behind the known risk factors for post-ERCP
pancreatitis, as well as the technical and medical approaches developed to prevent it. There have been many advances in identifying the causes of this condition. Based on this knowledge, a variety of preventive strategies have been developed and studied. The approach to prevention begins with careful patient selection and performing ERCP for specific indications, while considering alternative diagnostic modalities when appropriate. Patients should also be classified by high-risk factors such as young age, female sex, suspected
sphincter of Oddi dysfunction, a history of post-ERCP
pancreatitis, and normal serum
bilirubin, all of which have been identified in numerous research studies. The pathways of injury that are believed to cause post-ERCP
pancreatitis eventually lead to the common endpoint of
inflammation, and these individual steps can be targeted for preventive
therapies through procedural techniques and medical management. This includes the use of a guide wire for cannulation, minimizing the number of cannulation attempts, avoiding contrast
injections or
trauma to the pancreatic duct, and placement of a temporary pancreatic duct
stent in high-risk patients. Administration of rectal
non-steroidal anti-inflammatory agents (
NSAIDs) in high-risk patients is the proven pharmacological measure for prevention of post-ERCP
pancreatitis. The evidence for or against numerous other attempted
therapies is still unclear, and ongoing investigation is required.