Published online Aug 7, 2019. doi: 10.3748/wjg.v25.i29.4019
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
Endoscopic retrograde cholangiopancreatography (ERCP) has been used in the field of gastrointestinal endoscopy since its introduction as an important technological innovation. It is comparatively complex and can lead various complications. Post-ERCP pancreatitis (PEP) has been on the focus of the researches to investigate its prevention, since it has been considered to be the most common complication of ERCP.
Clinical trials have investigated different methods for the prevention of PEP. Each of these studies focused on a specific method. Our review gathered all preventative approaches for PEP investigated in the last ten years. Due to the conflicting data in the literature, advances in the reviewed field needed to be updated and supporting evidence needed review.
The objective of this study was to systematically review the literature on prevention of PEP with different preventive approaches.
We conducted an electronic search through databases of PubMed, ISI Web of Science and Cochrane Library for relevant articles performed via RCTs covering the time span of January 2009 and February 2019. The search was performed through terms “Post endoscopic retrograde cholangio-pancreatography pancreatitis” AND “prevention”. The reference lists of the identified papers were also scanned to find out further relevant studies.
54 studies were finally identified for full text review. The studies were categorized regarding prevention methods as (1) assessment of patient related factors, (2) pharmacoprevention and (3) procedural techniques for prevention. Female gender, young age, suspected Sphincter of Oddi dysfunction, absence of chronic pancreatitis, recurrent pancreatitis and history of previous PEP were the most common high risk factors for the patients to develop PEP. Rectally administered NSAIDs has been highly recommended for the prevention of PEP among the pharmacologic agents, while others had conflicting results and needed further research. Of the procedural techniques, Pancreatic Stent Placement and Endoscopic Nasobiliary Drainage can be beneficial in preventing PEP.
PEP is the most common complication in ERCP procedure and can be risky in patients with high risk factors. The pathophysiology of PEP is still in dispute. Due to its multifactorial pathophysiology, prevention of PEP should be assessed in multi aspects through evaluation of patient related risk factors, prophylaxis pharmacological agents and procedural techniques.
The multifactorial nature of PEP requires prophylaxis measures in multi facets. Due to its relation to a combination of various factors, multifactorial approach should be taken into account to prevent PEP through assessment of patient related risks and prophylaxis preventions of pharmacologic agents and procedural techniques.