Korean J Pancreas Biliary Tract.  2016 Apr;21(2):68-75. 10.15279/kpba.2016.21.2.68.

The Prevention and Management of Post-ERCP Pancreatitis

  • 1Department of Internal Medicine, Chungnam National University College of Medicien, Daejeon, Korea.
  • 2Division of Gastroenterology and Hepatology, Department of Internal Medicine, Daegu Fatima Hospital, Daegu, Korea. khsmhj@gmail.com


Complications that may occur after an endoscopic retrograde cholangiopancreatography (ERCP) procedure include pancreatitis, bleeding, cholangitis, cholecystis, perforation, and post-ERCP pancreatitis (PEP). Of these, PEP is the most common complication and 10% of patients can die from severe pancreatitis. Prevention of PEP requires the selection of an appropriate patient group according to their ERCP indications and a full awareness of the risk factors. The incidence rate can be reduced to some extent through medication and ERCP manipulation changes. The use of a spile through the guidewire during ERCP manipulation and temporary pancreatic duct stent insertion can be effective, and the administration of suppository NSAIDs as medication reduces the occurrence of PEP. Drugs such as glyceryl trinitrate (GTN), nafamostat, and somatostatin can be considered as the second best treatment in the cases where NSAIDs are contraindicated or where a plastic catheter cannot be inserted or fails after insertion into the pancreatic duct.


PEP; Rectal NASID; Pancreatic stent; Guide-wire cannulation
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