The Prevention, recognition and treatment of post-ERCP pancreatitis.

Acute pancreatitis is the most common and feared complication of endoscopic retrograde cholangiopancreatography (ERCP). It is associated with substantial morbidity and occasional mortality. The mechanisms that lead to post-ERCP pancreatitis are complex and not fully understood. Rather than having a single pathogenesis, post-ERCP pancreatitis is believed to be multi-factorial, involving a combination of chemical, hydrostatic, enzymatic, mechanical, and thermal factors. Although there is some uncertainty in predicting which patients will develop acute pancreatitis following ERCP, a number of risk factors acting independently or in concert have been proposed as predictors of post-ERCP pancreatitis [1, 2, 3, 4]. These include patient and procedure related factors. In patients at high risk for developing post-ERCP pancreatitis, numerous studies have attempted to identify endoscopic or pharmacologic interventions that might reduce the risk. The purpose of this review is to describe recent advances in the prevention and amelioration of post-ERCP pancreatitis.