Medical Prophylaxis vs. Pancreatic Stent for Prevention of Post-ERCP Pancreatitis

초록

Post-ERCP pancreatitis (PEP) remains the most common complication of ERCP and can give rise to serious clinical outcomes. The incidence rate of PEP has been reported ranging from 8.8% in average-risk to 14.1% in high-risk patients.1 There are various mechanisms proposed in the pathogenesis of PEP.2,3 These include: 1) mechanical injury from instrumentation of papilla and pancreatic duct; 2) thermal injury following application of electrosurgical current during biliary or pancreatic sphincterotomy; 3) hydrostatic injury - following injection of contrast medium into the pancreatic duct, or from infusion of water or saline solution during sphincter manometry; 4) chemical or allergic injury following injection of contrast medium into the pancreatic duct; 5) enzymatic injury with intraluminal activation of proteolytic enzymes; and 6) infection from contaminated endoscope and accessories.