Exposure to Iopamidol After Endoscopic Retrograde Cholangiopancreatography Assessing pancreatic toxicity

Iopamidol is an iodinated nonionic monomer and low-osmolar contrast medum (LOCM) used almost during each endoscopic retrograde cholangiopancreatography (ERCP) for visualization of either or both primary pancreatic or biliary ducts. During ERCP, the pancreas is exposed to chemical, hydrostatic or physical injury caused by injection of iopamidol solutions through the cannulated Vater ampulla. The aim of this paper is to assess recent literature findings of potential pancreatic toxicity of iopamidol and confront them with experimental findings, as post-ERCP pancreatitis is a severe, life threatening condition. Even if LOCM are considered safe in what post-ERCP pancreatitis is concerned, literature findings are discrepant. Nevertheless, iopamidol-containing water solutions were reported to cause pancreatic cell damage on both clinical and in vivo animal studies. Main toxic effect is considered that of osmolality. To conclude, larger, multicentric studies and better designed toxicity definitions are needed for a more thorough assessment of potential iopamidol-related post-ERCP pancreatitis.