Emerging Therapies to Prevent Post-ERCP Pancreatitis.

Nikhil R Thiruvengadam, Michael L Kochman

Journal: Current gastroenterology reports 2021;22(12):59

PMID: 33188441

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.

Address: Division of Gastroenterology and Hepatology, University of California San Francisco, 513 Parnassus Avenue, S-357, Box 0538, San Francisco, CA, 94143-0538, USA. [email protected].; Gastroenterology Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. [email protected].; Gastroenterology Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.; Center for Endoscopic Innovation, Research and Training, Perelman School of Medicine, Philadelphia, PA, USA.

DOI: 10.1007/s11894-020-00796-w