Post-ERCP Acute Pancreatitis

  • Bernd KronenbergerEmail author


Acute pancreatitis after ERCP (post-ERCP pancreatitis, PEP) occurs in 3–10% of patients. PEP is defined as clinical pancreatitis with amylase at least three times the upper limit of normal at more than 24 h after the procedure, requiring hospital admission or a prolongation of planned admission. Most patients have a mild or moderate self-limiting course of pancreatitis. In severe cases hemorrhagic pancreatitis, phlegmon, pseudocyst, infection, and multi-organ failure may develop. Mechanic and hydrostatic injury are regarded as major risk factors. Long cannulation time, several attempts for cannulation, precut, and injection of contrast material increase the risk for PEP. Patient-related risk factors include prior PEP, female sex, previous recurrent pancreatitis, suspected sphincter of Oddi dysfunction, and normal serum bilirubin level. Chronic pancreatitis has been demonstrated to be protective against PEP. Attenuation of the inflammatory reaction by nonsteroidal anti-inflammatory drugs; replacement of complete electrolyte infusion before, during, and after ERCP; and placement of pancreatic stents were shown to reduce the risk for PEP. Management of PEP depends on the severity of pancreatitis. In mild to moderate cases fluid replacement and pain management are sufficient. In severe cases with hemodynamic instability, systemic reactions, and organ failure, intensive care management is necessary.


Risk factors Nonsteroidal anti-inflammatory drugs Pancreatic stents Prevention Atlanta classification 


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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Internal Medicine, Gastroenterology, Hepatology, DiabetologyHerz-Jesu-HospitalFuldaGermany

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