Prevention, Detection, and Management of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) is a widely used diagnostic and therapeutic procedure for pancreaticobiliary diseases. However, its relatively invasive nature necessitates a thorough understanding of potential adverse events and appropriate preventive strategies. Post-ERCP pancreatitis (PEP), the most common ERCP-related adverse event, occurs in approximately 10% of cases. While often mild, severe cases can rapidly progress and lead to clinical deterioration and mortality. The pathogenesis of PEP involves direct tissue injury, impaired ductal drainage, inflammatory mediator release, and individual susceptibility. These insights have informed the currently employed prevention and management strategies. PEP risk factors include both patient- and procedure-related variables, underscoring the need for precise risk stratification and individualized procedural planning. Evidence-based preventive strategies— such as rectal nonsteroidal anti-inflammatory drugs, prophylactic pancreatic stent placement, aggressive intravenous hydration, guidewire-assisted cannulation, and other pharmacologic agents—have demonstrated efficacy in reducing PEP incidence. Future developments, including optimal combination strategies and machine learning–based risk prediction models, may further improve outcomes. Significantly reducing the burden of PEP requires integrating mechanistic insight and risk stratification with timely, evidence-based prevention and management.