European Journal of Biomedical and Pharmaceutical Sciences

PREVENTION OF POST-ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP) PANCREATITIS: A SYSTEMATIC REVIEW

Avtar Singh*, Sobner Aubourg, Farzeen Sharaf, Omar Rahim, Dr Devdat, Ugwonoh Nneka Cynthia, Shilpa Rai, Danish Waqar, Abdullah Shah, Ghulam Muhammad Humayun, Maha Niazi, Parvathy Surendran, Chidinma Vivian Ikekpeazu, Ayoola Awosika, Adekunle Ebenezer Omole and Attia Batool

ABSTRACT

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is a relatively complex procedure, with pancreatitis being this procedure's most commonly reported complication. Many randomized clinical trials (RCTs) have been conducted to assess the best prevention modality of post-ERCP pancreatitis (PEP). This systematic review aims to collate evidence from RCTs on the best modality for the prevention of PEP. Methods: A systematic search was conducted across the following databases: PubMed, Cochrane library, EBSCO, and Web of Science. Relevant articles were located between January 2012 through August 2022. The following keywords were used: ERCP, post-endoscopic retrograde cholangiopancreatography pancreatitis, prevention, and post-ERCP. Duplicates were manually removed. This systematic review was conducted adhering to PRISMA statement 2020 guidelines. The reference lists were additionally searched (umbrella methodology). Results: Of the 2482 studies that were identified, 2010 were reviewed for titles and abstracts. Finally, 28 articles were assessed for full-text eligibility, of which 13 RCTs met the inclusion criteria. The most commonly used prevention technique was Pancreatic Stent Placement (PSP) (n=977), which had a statistically significant reduced incidence of PEP. The second most commonly used methodology was Wire-Guided Biliary Cannulation (WGC) (n=1329), which showed overall protective findings. With Endoscopic Nasobiliary Drainage (ENBD) (n=153), there was an independent risk of patients acquiring PEP with the procedure. Lastly, Needle Knife Sphincterotomy (NKS) (n=73) showed no improvement in PEP. conclusion: There are multiple modalities of preventing PEP. Patients at high risk of post-ERCP complications must undergo both pharmacological and surgical prevention. In this systematic review, pancreatic stent placement was found to be the most effective technique to prevent PEP. It is, however, recommended that the administration of pharmacological agents, diagnostic procedures of PEP, and procedural techniques be optimized to reduce the patient burden of PEP.

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