Prevention of ERCP-induced Pancreatitis

Pancreatitis is a common, costly, and occasionally devastating complication of endoscopic retrograde cholangiopancreatography (ERCP). Since post-ERCP pancreatitis (PEP) is important and potentially preventable, a comprehensive approach to risk reduction should be employed by all who perform ERCP. Strategies to reduce the incidence of PEP, which should be considered in every case, include thoughtful patient selection, risk-stratification, 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. To this end, there are several ongoing and upcoming initiatives that will help elucidate the pathophysiology of PEP and optimize prophylactic interventions. Herein is an evidence-based review of approaches to prevent pancreatitis after ERCP, as well as an overview of pressing research questions in this important area.