摘要
Endoscopic retrograde cholangiopancreatography(ERCP)has continued to develop over recent decades with regard to both indications for its use and improvements in technique.The most common complication is post-ERCP pancreatitis(PEP)with incidence rates being reported at~10%.The exact mechanism of PEP is unknown but is likely multifactorial with papillary edema contributing to the activation of the inflammatory cascade playing an important role.Selected risk factors include patient-related factors(female sex,younger age,sphincter of Oddi dysfunction,and history of PEP)and procedure-related factors(difficult cannulation,multiple pancreatic duct guidewire passes,pancreatic acinarization,multiple pancreatic duct contrast injections,and precut sphincterotomy).Several preventative prophylactic strategies have been posited;however,current guidelines recommend the use of rectal non-steroidal anti-inflammatory drugs(NSAIDs),aggressive intravenous(IV)fluid hydration,and pancreatic duct stents.Appropriate patient selection and the use of noninvasive imaging modalities for diagnosis of pancreaticobiliary abnormalities is a key aspect in prevention.Future studies continue to explore various pharmacologic,procedure-related,and combination strategies for prevention and will be important as the use of ERCP continues to grow.
