Postgraduate Course at DDW: Complete Clinical Updates for Today's Practice | May 2025-13_Keswani

13_Keswani_PREVENTING POST-ERCP ACUTE PANCREATITIS

Pdf Summary

The document, authored by Dr. Rajesh N. Keswani, discusses strategies to prevent post-Endoscopic Retrograde Cholangiopancreatography (ERCP) acute pancreatitis, a common complication. The document outlines several approaches including:<br /><br />1. **Avoiding Unnecessary ERCP:** Methods to prevent unnecessary ERCP include not using ERCP for gut-brain interaction disorders, avoiding diagnostic ERCP where conditions are confirmed through non-invasive methods, and not performing ERCP for low to intermediate probability choledocholithiasis without confirmatory testing.<br /><br />2. **Intravenous Hydration:** Aggressive intravenous hydration with Lactated Ringer's solution (LR) is emphasized for its effectiveness in reducing post-ERCP pancreatitis rates. Studies suggest aggressive hydration is particularly beneficial when NSAIDs are not administered concurrently. Protocols involve administering LR at 2-3 mL/kg/hour during ERCP, combined with a 20 mL/kg bolus post-ERCP.<br /><br />3. **NSAIDs:** Rectal indomethacin, an NSAID, significantly reduces the risk of post-ERCP pancreatitis and should be used in high-risk populations. The challenge remains optimizing its usage across diverse patient groups.<br /><br />4. **Pancreas Stent:** The use of pancreatic stents in high-risk patients can offer additional protection against pancreatitis. However, placement should be carefully evaluated against procedural risks.<br /><br />5. **Modifying Technique:** Enhanced training and procedural skills can mitigate adverse outcomes. Techniques like primary fistulotomy and EUS-biliary drainage are discussed for their potential to reduce pancreatitis rates.<br /><br />Dr. Keswani's document highlights the importance of evidence-based approaches in minimizing ERCP-related complications. It draws on various studies to support aggressive hydration and NSAID use, while advocating for further research on technique modifications. The goal is to tailor strategies to patient risk profiles, optimizing preventative measures against post-ERCP acute pancreatitis.

Keywords

post-ERCP pancreatitis

Dr. Rajesh N. Keswani

ERCP prevention

intravenous hydration

NSAIDs

pancreatic stents

technique modification

Lactated Ringer's solution

rectal indomethacin

evidence-based approaches