Systematic Review
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 7, 2019; 25(29): 4019-4042
Published online Aug 7, 2019. doi: 10.3748/wjg.v25.i29.4019
Post-endoscopic retrograde cholangiopancreatography pancreatitis: A systematic review for prevention and treatment
Murat Pekgöz
Murat Pekgöz, Department of Gastroenterology, VM Medical Park Bursa Hospital, Bursa 16022, Turkey
Author contributions: Pekgöz M solely contributed to this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Murat Pekgöz MD, Assistant Professor, Department of Gastroenterology, VM Medical Park Bursa Hospital, Fevzi Cakmak Caddesi, Bursa 16022, Turkey.
Telephone: +90-532-6015967 Fax:+90-224-2235571
Received: March 15, 2019
Peer-review started: March 15, 2019
First decision: May 14, 2019
Revised: May 19, 2019
Accepted: July 1, 2019
Article in press: July 3, 2019
Published online: August 7, 2019

Post endoscopic retrograde cholangiopancreatography (ERCP) is comparatively complex application. Researchers has been investigated prevention of post-ERCP pancreatitis (PEP), since it has been considered to be the most common complication of ERCP. Although ERCP can lead various complications, it can also be avoided.


To study the published evidence and systematically review the literature on the prevention and treatment for PEP.


A systematic literature review on the prevention of PEP was conducted using the electronic databases of ISI Web of Science, PubMed and Cochrane Library for relevant articles. The electronic search for the review was performed by using the search terms “Post endoscopic retrograde cholangiopancreatography pancreatitis” AND “prevention” through different criteria. The search was restricted to randomized controlled trials (RCTs) performed between January 2009 and February 2019. Duplicate studies were detected by using EndNote and deleted by the author. PRISMA checklist and flow diagram were adopted for evaluation and reporting. The reference lists of the selected papers were also scanned to find other relevant studies.


726 studies meeting the search criteria and 4 relevant articles found in the edited books about ERCP were identified. Duplicates and irrelevant studies were excluded by screening titles and abstracts and assessing full texts. 54 studies were evaluated for full text review. Prevention methods were categorized into three groups as (1) assessment of patient related factors; (2) pharmacoprevention; and (3) procedural techniques for prevention. Most of studies in the literature showed that young age, female gender, absence of chronic pancreatitis, suspected Sphincter of Oddi dysfunction, recurrent pancreatitis and history of previous PEP played a crucial role in posing high risks for PEP. 37 studies designed to assess the impact of 24 different pharmacologic agents to reduce the development of PEP delivered through various administration methods were reviewed. Nonsteroidal anti-inflammatory drugs are widely used to reduce risks for PEP. Rectal administration of indomethacin immediately prior to or after ERCP in all patients is recommended by European Society for Gastrointestinal Endoscopy guidelines to prevent the development of PEP. The majority of the studies reviewed revealed that rectally administered indomethacin had efficacy to prevent PEP. Results of the other studies on the other pharmacological interventions had both controversial and promising results. Thirteen studies conducted to evaluate the efficacy of 4 distinct procedural techniques to prevent the development of PEP were reviewed. Pancreatic Stent Placement has been frequently used in this sense and has potent and promising benefits in the prevention of PEP. Studies on the other procedural techniques have had inconsistent results.


Prevention of PEP involves multifactorial aspects, including assessment of patients with high risk factors for alternative therapeutic and diagnostic techniques, administration of pharmacological agents and procedural techniques with highly precise results in the literature.

Keywords: Endoscopic retrograde cholangiopancreatography, Pancreatitis, Prevention, Treatment, Indomethacin, Stent replacement, Prophylaxis

Core tip: This study systematically reviewed the literature on the prevention and treatment for post Endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. PRISMA checklist and flow diagram were adopted for the evaluation and the reporting. Prevention methods were categorized in three groups as (1) assessment of patient related factors; (2) pharmacoprevention; and (3) procedural techniques for prevention. Patients with high risk factors should be carefully assessed, and alternative therapeutic and diagnostic techniques may be preferable for them instead of ERCP.