Unité d'endoscopie digestive diagnostique et interventionnelle, Hôpital Cochin, pavillon Achard, 27 rue du Faubourg St Jacques, 75014 Paris
Acute pancreatitis remains the most frequent procedure-related complication after ERCP. Some of the risk factors for post-ERCP pancreatitis have been clearly identified, in relation to the patient himself (young, female), to the indication for ERCP (sphincter of Oddi dysfunction, ampullectomy), or to the technique involved (pancreatic sphincterotomy, balloon sphincteroplasty). A better selection of patients before ERCP, technical tips and tricks and pharmacological means have been proposed as potential ways to reduce the incidence of post-ERCP pancreatitis. Numerous pharmacological agents have been tested, aiming at reducing the sphincter spasm, bilio-pancreatic infection and ischemia, the toxicity of contrast fluids, the inflammatory cascade as well as pancreatic excretion. Most trials have shown disappointing results, as demonstrated by several recently published meta-analyses. NSAIDs still present the most favourable outcome figure, but encouraging results need to be confirmed by large multicenter trials. From the technical point of view, the insertion of specifically designed plastic stents in the pancreatic duct after ERCP has gained a sufficient level of evidence to be recommended. However, this recommendation must be restricted to patients with the highest risk of post-ERCP pancreatitis, such as those undergoing an ampullectomy.