From the Research
High-risk patients in the context of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) are individuals with specific characteristics that increase their likelihood of developing PEP, such as female gender, younger age, normal bilirubin levels, suspected sphincter of Oddi dysfunction, difficult cannulation, pancreatic duct injection, pancreatic sphincterotomy, or previous history of PEP. These risk factors can compound, significantly increasing the chance of developing pancreatitis after ERCP procedures. The 35% incidence rate mentioned is considerably higher than the general population rate of 3-15%, suggesting this cohort consisted primarily of patients with multiple risk factors. Some of the key factors that contribute to the high risk of PEP include:
- Younger age, as shown in a study from 1, where the prevalence rate of PEP was higher in patients younger than 60 years old
- Pancreatic duct development, which was identified as an independent risk factor for PEP in the same study 1
- Suspected sphincter of Oddi dysfunction, as mentioned in a study from 2, which highlights the importance of appropriate indication and counseling for patients at increased risk for PEP
- Previous history of PEP, which is a well-established risk factor for PEP, as noted in several studies, including 3 Clinicians should identify these high-risk patients before procedures to implement preventive measures such as:
- Rectal NSAIDs, which have been shown to be effective in reducing the risk of PEP, as recommended by the European Society for Gastrointestinal Endoscopy guidelines and supported by studies such as 3
- Aggressive hydration, which may also help reduce the risk of PEP, although further studies are needed to confirm its effectiveness, as noted in 2
- Prophylactic pancreatic stent placement, which has been shown to be beneficial in preventing PEP, particularly in high-risk patients, as discussed in 4 Understanding these risk factors and implementing preventive measures can help reduce the incidence of PEP and improve patient outcomes.