Post-ERCP Pancreatitis Prevention Strategies

Publication Date: February 1, 2023
Last Updated: March 1, 2023

Summary of Recommendations

Among unselected patients undergoing ERCP, the ASGE recommends periprocedural rectal NSAIDs should be given to prevent PEP. (S, M)
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For high-risk patients undergoing ERCP, the ASGE recommends periprocedural rectal NSAIDs should be given to prevent PEP. (S, M)
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In unselected patients undergoing ERCP, the ASGE suggests wire-guided cannulation over contrast-guided cannulation to minimize the risk of PEP. (R, M)
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In patients undergoing ERCP with repeated or deep PD access or performance of ampullectomy, the ASGE recommends PD stents to reduce the risk of PEP. (S, M)
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Otherwise, in high-risk groups, including patients with difficult cannulation, history of PEP, or precut sphincterotomy without fistulotomy technique, the ASGE suggests PD stent placement as long as PD access can be easily achieved. (R, M)
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In unselected patients undergoing ERCP, the ASGE suggests aggressive periprocedural and postprocedural intravenous hydration to prevent PEP.

(R, M)
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Recommendation Grading

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.

Overview

Title

Post-ERCP Pancreatitis Prevention Strategies

Authoring Organization

Publication Month/Year

February 1, 2023

Last Updated Month/Year

September 7, 2023

Supplemental Implementation Tools

Document Type

Guideline

Country of Publication

US

Inclusion Criteria

Male, Female, Adolescent, Adult, Child, Older adult

Health Care Settings

Ambulatory, Hospital, Outpatient, Operating and recovery room

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Management, Prevention

Diseases/Conditions (MeSH)

D010195 - Pancreatitis

Keywords

pancreatitis, ERCP, post-ERCP, PEP

Source Citation

Buxbaum JL, Freeman M, Amateau SK, Chalhoub JM, Coelho-Prabhu N, Desai M, Elhanafi SE, Forbes N, Fujii-Lau LL, Kohli DR, Kwon RS, Machicado JD, Marya NB, Pawa S, Ruan WH, Sheth SG, Thiruvengadam NR, Thosani NC, Qumseya BJ; (ASGE Standards of Practice Committee Chair). American Society for Gastrointestinal Endoscopy guideline on post-ERCP pancreatitis prevention strategies: summary and recommendations. Gastrointest Endosc. 2023 Feb;97(2):153-162. doi: 10.1016/j.gie.2022.10.005. Epub 2022 Dec 12. PMID: 36517310.