Delayed Onset Post-ERCP Pancreatitis (DOPE-P)

Abstract

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.