PMID: 11900675Mar 20, 2002Paper

Predicting and preventing post-ERCP pancreatitis

Current Gastroenterology Reports
John Baillie

Abstract

Pancreatitis is rightly the most feared complication of endoscopic retrograde cholangiopancreatography (ERCP). Ten percent to 15% of cases of post-ERCP pancreatitis (PEP) are severe by clinical and radiologic criteria. Such cases carry significant morbidity and mortality and are responsible for the vast majority of ERCP-related deaths. The prediction and prevention of PEP have been of great interest to endoscopists since the introduction of ERCP 30 years ago. Prediction and diagnosis of PEP have become more accurate with the widespread availability of serum amylase estimation. A variety of cytokines (eg, interleukin -1, IL-6, and IL-8) and acute phase reactants (eg, C-reactive protein) are also elevated in the serum in acute pancreatitis, and these form the basis of evolving tests for PEP. Urine testing (for amylase) in acute pancreatitis is obsolete, but it may soon undergo a revival in the form of a rapid (3-minute) dipstick test for trypsinogen-2, a sensitive and specific test for this disease. The prevention of PEP takes multiple forms. The following steps are recommended for clinicians: 1) avoid ERCP when other, less invasive or noninvasive imaging tests can do the job (eg, CT or magnetic resonance imaging); 2) avoid high-...Continue Reading

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Citations

May 3, 2003·Lancet·R M S MitchellJ Baillie
Sep 7, 2011·Pancreatology : Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]·Wence ZhouXiaoliang Zhu
Oct 24, 2006·Gastrointestinal Endoscopy·Konstantinos C ThomopoulosVassiliki N Nikolopoulou
Mar 14, 2007·Journal of Gastroenterology·Ghalib H AbidBasil J Ammori

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