Nikhil R Thiruvengadam1,2, Michael L Kochman3,4. 1. Division of Gastroenterology and Hepatology, University of California San Francisco, 513 Parnassus Avenue, S-357, Box 0538, San Francisco, CA, 94143-0538, USA. Nikhil.Thiruvengadam@ucsf.edu. 2. Gastroenterology Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. Nikhil.Thiruvengadam@ucsf.edu. 3. Gastroenterology Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. 4. Center for Endoscopic Innovation, Research and Training, Perelman School of Medicine, Philadelphia, PA, USA.
Abstract
PURPOSE OF REVIEW: The aim of this review is to evaluate emerging, novel therapies for the prevention of post-ERCP pancreatitis. RECENT FINDINGS: Rectal indomethacin reduces the risk of pancreatitis in low- and average-risk patients, who comprise the majority of patients undergoing ERCP. An 8-h protocol of aggressive lactated Ringer's reduces the risk of pancreatitis in average-risk patients. Sublingual nitrate may provide additional benefit to rectal NSAIDs in preventing PEP. A tacrolimus trough > 2.5 ng/mL was recently shown to be associated with a lower risk of PEP in liver transplant patients undergoing ERCP. Routine usage of rectal indomethacin in all patients undergoing ERCP reduces the risk of PEP. Pancreatic-duct stents reduce the risk of PEP in high-risk patients. There is emerging data that aggressive hydration with lactated Ringer's and nitrates may further reduce PEP. Tacrolimus is a promising potential agent to prevent PEP but needs further clinical study.
PURPOSE OF REVIEW: The aim of this review is to evaluate emerging, novel therapies for the prevention of post-ERCP pancreatitis. RECENT FINDINGS: Rectal indomethacin reduces the risk of pancreatitis in low- and average-risk patients, who comprise the majority of patients undergoing ERCP. An 8-h protocol of aggressive lactated Ringer's reduces the risk of pancreatitis in average-risk patients. Sublingual nitrate may provide additional benefit to rectal NSAIDs in preventing PEP. A tacrolimus trough > 2.5 ng/mL was recently shown to be associated with a lower risk of PEP in liver transplant patients undergoing ERCP. Routine usage of rectal indomethacin in all patients undergoing ERCP reduces the risk of PEP. Pancreatic-duct stents reduce the risk of PEP in high-risk patients. There is emerging data that aggressive hydration with lactated Ringer's and nitrates may further reduce PEP. Tacrolimus is a promising potential agent to prevent PEP but needs further clinical study.
Authors: Robert L Kruse; Yuting Huang; Thomas Shum; Lu Bai; Hui Ding; Zack Z Wang; Florin M Selaru; Vivek Kumbhari Journal: Gastrointest Endosc Date: 2021-06-29 Impact factor: 9.427