From the Guidelines
The risk of post-Endoscopic Retrograde Cholangiopancreatography (ERCP) pancreatitis is significantly higher in pregnant women, with a reported rate of 12% compared to 5% in non-pregnant women, as indicated by a 2016 national cohort study 1. To understand the risk of post-ERCP pancreatitis, it's essential to consider the various factors that contribute to this complication. The study published in 2024 1 highlights the importance of minimizing fetal radiation exposure and pre- and post-procedure fetal monitoring when performing ERCP during pregnancy.
Some key points to consider:
- Pregnancy is an independent risk factor for post-ERCP pancreatitis, with a higher rate of 12% compared to 5% in non-pregnant women 1.
- The risk of post-ERCP pancreatitis is also higher in nonteaching vs teaching hospitals, emphasizing the need for experienced endoscopists and multidisciplinary care 1.
- Technical factors, such as limiting cannulation attempts and avoiding pancreatic duct contrast injection, can help reduce the risk of post-ERCP pancreatitis 1.
- Preventive measures, including rectal indomethacin and aggressive IV hydration, can be effective in reducing the risk of post-ERCP pancreatitis, especially in high-risk patients 1.
It's crucial to weigh these factors and consider the most recent and highest-quality evidence when assessing the risk of post-ERCP pancreatitis, particularly in vulnerable populations like pregnant women. The American Society for Gastrointestinal Endoscopy guidelines recommend deferral of endoscopy to the second trimester, whenever possible, to minimize risks 1.
From the Research
Risk of Post-ERCP Pancreatitis
- The risk of post-ERCP pancreatitis is a significant concern, with a reported incidence of 3.1% in a study of 1,512 ERCP procedures 2.
- The use of rectal diclofenac, a nonsteroidal anti-inflammatory drug (NSAID), has been shown to be ineffective in preventing post-ERCP pancreatitis in non-selected consecutive patients 2.
- However, other studies suggest that NSAIDs, including rectal indomethacin, can be effective in preventing post-ERCP pancreatitis, particularly in high-risk groups 3, 4.
- The rectal route for NSAIDs has been found to be favorable for preventing post-ERCP pancreatitis, with a study showing that rectal diclofenac demonstrates favorable blood pharmacokinetics and systemic bioavailability, as well as sustained pancreas penetration 5.
Factors Influencing the Risk of Post-ERCP Pancreatitis
- Patient-related and procedure-related factors, such as risk factors for post-ERCP pancreatitis, can influence the risk of developing pancreatitis after ERCP 2, 4.
- The severity of post-ERCP pancreatitis can also vary, with some studies reporting similar severity in patients who received rectal diclofenac and those who did not 2.
Prevention of Post-ERCP Pancreatitis
- Several measures can be undertaken to decrease the risk of post-ERCP pancreatitis, including pancreatic duct stenting and rectal indomethacin 4.
- Advances in risk stratification, patient selection, procedure technique, and prophylactic interventions have substantially improved the ability to prevent post-ERCP pancreatitis 6.