An Insight on Pharmacological and Mechanical Preventive Measures of Post-ERCP PANCREATITIS (PEP)—A Review
Abstract
:1. Introduction
2. Risk Factors
3. Prevention
3.1. Pharmacological Prophylaxis
3.1.1. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
3.1.2. Somatostatin/Octreotide
3.1.3. Sublingual Nitrates
3.1.4. Aggressive Hydration with Lactated Ringer’s Solution
3.1.5. Miscellaneous Medicinal Chemicals
3.2. Mechanical Prevention
3.2.1. Prophylactic Pancreatic Stenting
3.2.2. Biliary Cannulation
3.2.3. Needle-Knife Precut Sphincterotomy
3.2.4. Transpancreatic Precut Sphincterotomy (TPS)
3.2.5. The Wire-Guide Cannulation (WGC) Technique
4. Combined Prevention
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Types | Severity Grading | ||
---|---|---|---|
Mild | Moderate | Severe | |
Cotton et al. [3] | • Clinical pancreatitis • Amylase at least three times more than normal at 24 h after the procedure • Requiring admission or prolongation of planned admission to 2–3 days | • Requiring hospitalization of 4–10 days | • Hospitalization for more than 10 days OR Hemorrhagic pancreatitis, phlegmon pseudocyst, or intervention OR Need for percutaneous drainage or surgery |
Bank et al. [4] | • No organ failure • No local or systemic complications | • Organ failure that resolves within 48 h (transient organ failure) OR Local or systemic complications without persistent organ failure | • Persistent organ failure (>48 h) (single or multiple organ failure) |
Risk Factors | Odds Ratios |
---|---|
Patient-related risk factors | |
●Female sex [14,15] | 1.40–2.23 |
●Previous pancreatitis [14,15] | 2.00–2.90 |
●Previous PEP [14,15] | 2.90–8.50 |
●Suspected SOD [14,15] | 2.04–4.37 |
●Intraductal papillary mucinous neoplasm (IPMN) [15] | 3.01 |
Patient-related likely risk factors | |
●Age [9,11,13] | 1.60–3.97 |
●Obesity [16] | 1.143 |
●Taken potent pancreatotoxic drugs [17] | 3.70 |
Procedure-related risk factors | |
●Difficult cannulation [14,15] | 3.49–14.9 |
●Pancreatic injection [14,15] | 1.58–2.72 |
●Precut sphincterotomy [14,15] | 2.11–3.10 |
●Non-prophylactic pancreatic duct stent [10,14] | 1.84–2.10 |
●Difficult cannulation [14,15] | 3.49–14.9 |
Procedure-related likely risk factors | |
●Trainee involvement [9] | 1.5 |
●Extent of pancreatogram [13] | 9.516 |
First Author | Country | Study Design | |
---|---|---|---|
The Aggressive Hydration (AH) Group | The Standard Hydration (SH) Group | ||
Buxbaum et al. [49,50] | USA | 3.0 cc/kg/h during the procedure, a bolus of 20 cc/kg immediately after ERCP, followed by a post-ERCP rate of 3.0 cc/kg/h for 8 h | 1.5 cc/kg/h during ERCP and for 8 h after ERCP without a bolus |
Shygan-Nejad et al. [50] | Iran | 3.0 cc/kg/h during ERCP, a bolus of 20 mL/kg right after ERCP and 3.0 cc/kg/h of lactatedRinger solution for 8 h | 1.5 cc/kg/h during ERCP and the following 8 h |
Choi et al. [49,50] | Korea | 10 cc/kg before ERCP, 3.0 cc/kg/h during and for 8 h after ERCP, and a post-ERCP bolus of 10 cc/kg | 1.5 cc/kg/h during and for 8 h after ERCP |
Park et al. [50] | Korea | 20-mL/kg bolus and 3 cc/kg/h for 8 h after ERCP | 1.5 cc/kg/h during and for 8 h after ERCP |
Shaygan- Nejad et al. [49,50] | Iran | 3 mL/kg/h during ERCP, 3 mL/kg/h for 8 h after the procedure to 20 mL/kg | 1.5 mL/kg/h during and for 8 h after procedure |
Shows Consistent Benefit a | Possible Benefits/ Unclear b | No Benefit c |
---|---|---|
Pharmacological agents | ||
Rectal NSAIDs | Gabexate mesilate | Corticosteroid |
Glyceryl trinitrate | Somatostatin/ Octreotide | Nifedipine |
Aggressive hydration with Lactated Ringer’s solution | Ulinastatin | Lidocaine |
Allopurinol | Heparin | |
gabexate mesylate | ||
Mechanical measures | ||
Prophylactic pancreatic stenting | Needle-knife precut sphincterotomy | |
The wire-guide cannulation (WGC) technique | Transpancreatic precut sphincterotomy (TPS) | |
Combined prevention | ||
Rectal NSAIDs plus prophylactic pancreatic stenting | Rectal NSAIDs plus somatostatin | Rectal indomethacin plus topical epinephrine |
Rectal NSAIDs plus sublingual nitrates | Lactated Ringer’s solution plus indomethacin | |
The double-guidewire technique (DGT) with prophylactic pancreatic stenting |
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Zhang, Y.; Liang, Y.; Feng, Y. An Insight on Pharmacological and Mechanical Preventive Measures of Post-ERCP PANCREATITIS (PEP)—A Review. Gastroenterol. Insights 2022, 13, 387-403. https://doi.org/10.3390/gastroent13040038
Zhang Y, Liang Y, Feng Y. An Insight on Pharmacological and Mechanical Preventive Measures of Post-ERCP PANCREATITIS (PEP)—A Review. Gastroenterology Insights. 2022; 13(4):387-403. https://doi.org/10.3390/gastroent13040038
Chicago/Turabian StyleZhang, Yinqiu, Yan Liang, and Yadong Feng. 2022. "An Insight on Pharmacological and Mechanical Preventive Measures of Post-ERCP PANCREATITIS (PEP)—A Review" Gastroenterology Insights 13, no. 4: 387-403. https://doi.org/10.3390/gastroent13040038