Acute pancreatitis remains the most common complication of endoscopic retrograde cholangiopancreatography ercp. Endoscopic sphincterotomies were performed in 577 patients. The severity of pep is mainly based on the length of hospitalization, as illustrated in table 2. These measures include pancreatic duct stenting and.
The patient developed acute abdominal pain and was admitted to rule out post ercp pancreatitis. Pancreatitis is the most common complication of endoscopic retrograde cholangio pancreatography ercp and carries a high morbidity and mortality 1, 2. Necrotising pancreatitis, pseudocysts, pancreatogenic ascites and infection have been reported. Several scoring systems have been validated in predicting the severity of pancreatitis, including the bedside index for. Fluid hydration to prevent postercp pancreatitis in average to. All structured data from the file and property namespaces is available under the creative commons cc0 license.
Considerable efforts have been made to identify factors that may be associated with an increased risk of this complication. A 74yearold man is admitted to the hospital with acute gallstone pancreatitis without evidence of coexisting ascending cholangitis or biliary obstruction. Endoscopic retrograde cholangiopancreatogra phy ercp has become almost exclusively a ther apeutic procedure. Nonuse of vigorous hydration was associated with a 2. There is a 3%5% incidence of this complication occurring, as shown in various large clinical studies24. Acute pancreatitis is the most common serious complication of endoscopic retrograde cholangiopancreatography ercp 1,2. In total, 2028 ercp procedures were performed in 1 patients with cp and 2000 procedures in 1655 patients with bd. We identified patient and procedurerelated risk factors for postercp pancreatitis and the impact of the endoscopists experience and the centers case volume, using univariate and multivariate. Pancreatitis after ercp is one of the most common ercp complications. Management of postercp pancreatitis europe pmc article. Acute pancreatitis occurs in approximately 5% of diagnostic procedures and 10% of therapeutic procedures.
Patient presents with pseudoaneurysm right femoral artery due to. Endoscopic retrograde cholangiopancreatography ercp is an established treatment modality for bile duct disorders, but patients have a risk of postercp pancreatitis pep and biliary sepsis. Complications of ercp include pancreatitis, bleeding, cholangitis, cholecystitis, and perforation. The incidence of postercp pancreatitis pep varies from 1% to 40% partly as a result of the definition of pep, but figures of 1. During ercp, an endoscope a fiberoptic containing, flexible, hoselike instrument is swallowed and passed through the stomach and into the first part of the small intestine, the. In most cases, pancreatitis after ercp resolves on its own without intensive medical treatment. Single rectal administration of nsaids is useful for the prevention of postercp pancreatitis relative risk rr 0. A variety of patientrelated and procedurerelated factors have been identified to riskstratify patients. Endoscopic retrograde cholangiopancreatography ercp.
Frequency and risk factors in the postercp pancreatitis. A prior history of ercpinduced pancreatitis is also a risk factor. Endoscopic retrograde cholangiopancreatography ercp is a specialized procedure used for the diagnosis and treatment of pancreatic and biliary system. Acute pancreatitis is the most common and feared complication of endoscopic retrograde cholangiopancrea tography ercp. However, pancreatitis can be lifethreatening in severe cases. Clinical practice guideline for postercp pancreatitis. Of all the currently performed gastrointestinal endoscopic procedures it carries the highest complication rate. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Incidence and risk factors for postercp pancreatitis in. Prevention of post endoscopic retrograde cholangiopancreatography pancreatitis atsushi sofuni and takao itoi department of gastroenterology and hepatology, tokyo medical university hospital, japan 1. Acute pancreatitis is a common and dreaded complication of endoscopic retrograde cholangiopancreatography ercp that continues to disturb endoscopists since the inception of this technique.
Additionally, ercp for pancreatitis poses the risk of. Pancreatitis with an unusual fatal complication following. Perforation is one of the most feared complications of endoscopic retrograde cholangiopancreatography ercp. Advanced chronic pancreatitis, on the other hand, confers some immunity against ercppancreatitis, perhaps because of atrophy and decreased enzymatic activity. Files are available under licenses specified on their description page. This complication is most often related to the dye used. Pancreatitis incidence pancreatitis is the most common serious ercp complication. However, cp patients had significantly lower rates of moderate and severe attacks 0% vs 1. Postendoscopic retrograde cholangiopancreatography.
Ercp is associated with a 5%10% risk of pancreatitis. Diagnostic ercp with or without sphincter of oddi manometry som was performed in 536 patients 48. Postendoscopic retrograde cholangiopancreatography ercp pancreatitis pep is the most common complication of ercp and may run a. Joseph elmunzer3, alberto mariani4, tobias meister5, jacques deviere6, tomasz marek7, todd h. Prevention of postercp pancreatitis pubmed central pmc. The european society for gastrointestinal endoscopy guidelines recently recommended prophylactic rectal indomethacin for all patients undergoing ercp, including. It addresses the prophylaxis of postendoscopic retrograde cholangiopancreatography postercp pancreatitis. The diagnosis and management of all complications of ercp are beyond the scope of this document. An overview of the complications of ercp and detailed discussions of other individual complications are presented separately. Johns hopkins hospital admissions for postercp pancreatitis, singh says the condition isnt common, but it is dangerousand preventable. Somatostatin for prevention of postercp pancreatitis. Incidence of postercp pancreatitis was significantly lower in the vigorous hydration group compared with the standard group both overall 4. Postercp pancreatitis pep is the most common serious adverse event attributed to the procedure, result ing in annual estimated costs exceeding 150 million. Ercp endoscopic retrograde cholangiopancreatography is a procedure for obtaining xrays of the bile and pancreatic ducts which carry the fluids produced by the liver and pancreas into the intestine.
Many medical professionals and researchers argue that ercp for pancreatitis may aggravate the condition. European society of gastrointestinal endoscopy esge. Several measures can be undertaken in order to decrease the risk of postercp pancreatitis in highrisk groups. History of previous postercp pancreatitis was found to be a potent risk factor or 5. Pancreatitis is the most common complication of endoscopic retrograde cholangio pancreatography ercp and carries a high morbidity and mortality1,2. The absence of chronic pancreatitis and female gender are moderately involved as risk factors for percpap, with or 1. Pancreatitis is the most common complication of ercp. In addition, both procedure and pharmacologicalrelated interventions.
Pancreatitis requiring hospitalization of 410 days a hospitalization for more than 10 days or b development of hemorrhagic pancreatitis, phlegmon, pseudocyst, or infection or c need for percutaneous drainage or surgery revised atlanta classification9,y. To evaluate the effectiveness and safety of pancreatic stent for prophylaxis of pep and biliary sepsis in highrisk patients with complicating common bile duct cbd disorders. However, postercp pancreatitis is usually mild and selflimiting. Additionally, ercp is known to cause pancreatitis in cases where pancreatitis did not previously exist. Almost one in 10 outpatients develops pancreatitis after the procedure. Pancreatic stenting reduces postercp pancreatitis and. In this patient population, more than a quarter of. Endoscopic retrograde cholangiopancreatography erpc is used for diagnosis and treatment of pancreatic diseases and biliary tract diseases. Rectal indomethacin, a nonsteroidal antiinflammatory drug, is given to prevent pancreatitis in highrisk patients undergoing endoscopic retrograde cholangiopancreatography ercp, based on findings from clinical trials. A commonly used definition of postercp pancreatitis is abdominal pain for 24 hours after the procedure and levels of serum pancreatic enzymes three times above normal. It is reported to occur in 210% of unselected patient samples and up to 40% of highrisk patients. A systematic survey of 21 studies involving 16855 patients 19872003 found a 3. Pancreas divisum is only a risk factor if minor papilla cannulation is. Of these complications, postercp pancreatitis pep is the most.
Freeman considers that chronic pancreatitis is a protective factor against post ercp pancreatitis, his arguments being the parenchymal atrophy and reduced enzymatic secretion present in the illness. Gastrointestinal bleeding, infection, and adverse reactions to the sedative anesthesia are other, rare complications associated with ercp. Pancreatitis or inflammation of the pancreas is a common complication with ercp. Symptoms of ercp complications ercp malpractice ercp. Introduction endoscopic retrograde cholangiopancreatography ercp is an essential modality for the. Most cases of pancreatitis are mild, meaning that they require a few extra days in the hospital but have no longterm problems. Systemic complications leading to multiorgan failure are the usual cause of death in cases of pancreatitis. The figures cited in literature vary from 1 7% to 12 31%. About 57% of patients experience pancreatitis after ercp. Pancreatitis is one of the most common complications of endoscopic retrograde cholangiopancreatography ercp. One of the primary symptoms of pancreatitis after ercp is abdominal pain. When obtaining a patients informed consent to perform endoscopic retrograde cholangiopancreatography ercp, many endoscopists quote a postercp pancreatitis pep rate of 35%.
Winstonsalem, nc, usa introduction acute pancreatitis is the most common and feared. However, in some cases it can become complicated and lifethreatening. An elevation in the serum amylase concentration is common after endoscopic retrograde cholangiopancreatography ercp, occurring in up to 75 percent of patients. Protocolbased medical management of postercp pancreatitis. Folsch et al mortality in the severe pancreatitis group was 626 in the ercp arm and 220 in the conservative arm p 0. Pdf risk factors for postercp pancreatitis in high and. Hence, the minimization of both the incidence and severity of postercp pancreatitis is paramount.