Treatment of Acute Pancreatitis in Patients at High Risk of Post-ERCP Pancreatitis
Post-ERCP pancreatitis (PEP) is a clinically significant complication of endoscopic retrograde cholangiopancreatography. Patients identified as high risk require a proactive, evidence-based prophylactic strategy at the time of the procedure.
Clinical Scenario
This protocol targets patients undergoing ERCP who are considered at high risk of developing post-ERCP pancreatitis. Risk stratification before or during the procedure guides the need for prophylaxis.
Approach
Evidence-based prophylaxis in this setting centres on rectal indomethacin administered in close proximity to the ERCP procedure. For selected high-risk patients, placement of a pancreatic duct stent may be considered alongside pharmacological prophylaxis.
The complete structured regimen — including sequencing, all clinical considerations, and decision criteria — is available via the link below.
References
DOI: 10.14309/ajg.0000000000002645
- We recommend rectal indomethacin to prevent post-ERCP pancreatitis (PEP) in individuals considered to be at high risk of PEP.
- We suggest placement of a pancreatic duct stent in patients at high risk for PEP who are receiving rectal indomethacin.
- Multiple studies have shown that a single dose of 100 mg of rectal indomethacin before or immediately after ERCP will prevent PEP in patients at high risk.