Department of Gastroenterology, Metro Heart Institute with Multispeciality, Faridabad, Haryana, IndiaIndia
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Post Endoscopic retrograde cholangiopancreatography (ERCP) Pancreatitis (PEP) is defined as new onset or worsening of pain abdomen after ERCP with an elevation of pancreatic en-zymes (amylase/lipase) more than 3 times upper limit of normal after 24 hours of procedure and prolongation of hospital stay/planned admission.1,2,3 The overall incidence of PEP is estimated to be 3-10%.1,2,3 Various risk factors found in multivariate trials are divided into patient-related risk factor (prior PEP, female sex, young patient, normal bilirubin, previous recurrent pancreatitis, suspected sphincter of Oddi dysfunction, absence of chronic pan-creatitis) and procedure-related risk factors (difficult cannulation i.e. >10 minutes cannulation time, repetitive pancreatic duct guide wire cannulation, pancreatic duct contrast injection, pancreatic sphincterotomy, endoscopic papillary large-balloon dilatation of an intact sphincter). Placement of prophylactic pancreatic stents (PPSs) usually advocated in high-risk patients and reduced PEP rate by 60-80%.4,5 3 Fr stents have higher migration rate and hence 5 Fr stents are superior to 3 Fr. Studies have shown that if place-ment of pancreatic stent is attempted but fails risk of PEP in-creases.
Keywords: pancreatic sphincterotomy, endoscopic papillary large-balloon dilatation of an intact sphincter
PANCREAS PUBLISHERS ISSN 2471-142X Open Journal Vishal Khurana, MBBS, MD, DM, MNAMS* Department of Gastroenterology, Metro Heart Institute with Multispeciality, Faridabad, Haryana, India *Corresponding author Vishal Khurana, MBBS, MD, DM, MNAMS Consultant, Department of Gastroenterology, Metro Heart Institute with Multispeciality, Faridabad, Haryana, India; E-mail: vishdoc24@gmail.com Article information Received: May 7th, 2018; Accepted: August 2nd, 2018; Published: August 8th, 2018 Cite this article Khurana V. Delayed onset post-ERCP pancreatitis (DOPE-P). Pancreas Open J. 2018; 2(1): e8-e9. doi: 10.17140/POJ-2-e008 Delayed Onset Post-ERCP Pancreatitis (DOPE-P) Editorial Editorial | Volume 2 | Number 1| e8 Copyright 2018 by Khurana V. This is an open-access article distributed under Creative Commons Attribution 4.0 International License (CC BY 4.0), which allows to copy, redistribute, remix, transform, and reproduce in any medium or format, even commercially, provided the original work is properly cited. cc P ost Endoscopic retrograde cholangiopancreatography (ERCP) Pancreatitis (PEP) is defined as new onset or worsening of pain abdomen after ERCP with an elevation of pancreatic en- zymes (amylase/lipase) more than 3 times upper limit of normal after 24 hours of procedure and prolongation of hospital stay/ planned admission.1,2,3 The overall incidence of PEP is estimated to be 3-10%. 1,2,3 Various risk factors found in multivariate trials are divided into patient-related risk factor (prior PEP , female sex, young patient, normal bilirubin, previous recurrent pancreatitis, suspected sphincter of Oddi dysfunction, absence of chronic pan- creatitis) and procedure-related risk factors (difficult cannulation i.e. >10 minutes cannulation time, repetitive pancreatic duct guide wire cannulation, pancreatic duct contrast injection, pancreatic sphincterotomy, endoscopic papillary large-balloon dilatation of an intact sphincter). Placement of prophylactic pancreatic stents (PPSs) usually advocated in high-risk patients and reduced PEP rate by 60-80%.4,5 3 Fr stents have higher migration rate and hence 5 Fr stents are superior to 3 Fr. Studies have shown that if place- ment of pancreatic stent is attempted but fails risk of PEP in- creases.6 There is scarce data available on incidence and severity of delayed onset post ERCP pancreatitis (DOPE-P).7,8 DOPE-P is defined as the development of features of pancreatitis after the first 24 hrs of ERCP . It can occur in two situations: either early migration of prophylactic pancreatic duct (PD) stent within first day of ERCP or after endoscopic removal of PD stent. A ret- rospective cohort study of 230 patient undergoing PPS removal has shown 3% incidence of pancreatitis after pancreatic stent re- moval. Statistical significant risk factors found in this study were use of 5 fr a stent, stent with internal flange and history of PEP after initial ERCP .8 Probable etiology of DOPE-P is trauma to PD caused by stent removal. There is a need for a prospective trial for incidence, severity and prevention of DOPE-P . Judicious use of PPS in the only high-risk ERCP with slow removal of PPS within 5-10 days or pharmacoprophylaxis with rectal Nonsteroidal anti- inflammatory drug (NSAIDs), if stent removal done after 10 days, it may theoretically decrease the incidence of DOPE-P . Guidelines recommends evaluation of self-migration of PPS within 5-10 days of placement and endoscopic removal if stent do not migrate with 5-10 days.1 CONFLICTS OF INTEREST None.