ERCP Bootcamp: Cutting Edge Comprehensive Training for the Team | July 2026-Preventing Pancreatitis

Preventing Pancreatitis – pre, post, and procedural options

Video Transcription

Video Summary

Dr. Jessica Widmer discussed preventing post-ERCP pancreatitis, explaining its causes and risk factors, including duct injury, contrast pressure, sphincter spasm, difficult cannulation, pancreatic duct injection, and prior pancreatitis. She reviewed key prevention strategies: aggressive lactated Ringer’s hydration, rectal NSAIDs such as indomethacin, wire-guided cannulation, and prophylactic pancreatic duct stenting in high-risk cases. Evidence showed NSAIDs significantly reduce pancreatitis risk, with no major increase in bleeding or renal injury, and are recommended for most patients unless contraindicated. IV fluids also lower risk and may reduce severity, though the benefit of adding aggressive hydration to NSAIDs was less clear. She emphasized that pancreatic duct stents can reduce pancreatitis substantially, but require follow-up to ensure migration or removal. Overall, ASGE guidance supports using rectal indomethacin, IV fluids, wire-guided cannulation, and selective stenting to minimize post-procedural pancreatitis.

Asset Subtitle

Jessica Widmer, DO, FASGE

Keywords

post-ERCP pancreatitis

rectal indomethacin

lactated Ringer's hydration

pancreatic duct stenting

wire-guided cannulation