ASGE Endoscopy Course at ACG: Everyday Endoscopy: Expertise Meets Evidence (On-demand)

7_Buxbaum PEP Prevention

Pdf Summary

The document focuses on strategies for preventing Post Endoscopic Retrograde Cholangiopancreatography (ERCP) Pancreatitis (PEP), a common complication of ERCP procedures. It highlights diagnostic criteria and the variations in severity of PEP, emphasizing its significant burden with a 10.2% occurrence rate overall, rising to 14.1% in high-risk patients, and costing the US healthcare system about $200 million annually. Prevention is crucial to mitigate significant morbidity and stress associated with PEP.<br /><br />Key strategies to prevent PEP include assessing technical and patient-related risk factors. Technical risks are associated with difficult cannulation, pancreatic injections, and procedures like precut sphincterotomy and balloon dilation. Patient-related risks include suspected Sphincter of Oddi dysfunction (SOD), especially type III, and demographic factors like young age and female gender.<br /><br />The document advocates for avoiding ERCP unless necessary, suggesting Magnetic Resonance Cholangiopancreatography (MRCP) and Endoscopic Ultrasound (EUS) as non-invasive alternatives. It emphasizes using pancreatic stents in high-risk cases to significantly reduce PEP occurrence without increasing risks of other complications.<br /><br />Pharmacological interventions using Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), particularly rectal indomethacin, have been shown to effectively reduce PEP in both high-risk and general populations. Aggressive hydration, especially in inpatient settings, is suggested as a complementary strategy, although the effectiveness needs further exploration.<br /><br />Future strategies may involve combination therapies and novel pharmacological agents to improve prevention outcomes. Ongoing studies focus on interventions like CRAC inhibitors and statins to further mitigate PEP risks. The document stresses the importance of understanding risk factors and adopting a multidisciplinary approach to optimize ERCP safety and effectiveness.

Keywords

Post-ERCP Pancreatitis

PEP prevention

ERCP complications

risk factors

pancreatic stents

NSAIDs

rectal indomethacin

non-invasive alternatives

aggressive hydration

multidisciplinary approach