Post–endoscopic retrograde cholangiopancreatography pancreatitis prophylaxis: a stratified assessment for evaluation of risk approach

iGIE Pub Date : 2026-09-01 Epub Date: 2025-10-17 DOI:10.1016/j.igie.2025.10.009

David S. Braun MD, Prashant S. Kedia MD, Mingyang Cui MSc, Paul R. Tarnasky MD

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Abstract

Background and Aims

The risk of post–endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is influenced by patient and procedure-related factors. Strategies to decrease PEP are of great importance. This study aimed to determine if PEP prophylaxis (PEPX) could be avoided in patients in whom high-risk procedure-related factors are avoided as guided by a Stratified Assessment for Evaluation of Risk (SAFER) approach. SAFER is a dynamic process whereby procedure-related factors direct PEPX strategies.

Methods

A prospective database of consecutive ERCPs was analyzed. Data regarding demographics, procedure indications, previous ERCP attempts, cannulation techniques, PEPX received, and adverse events were collected. Each ERCP was classified for PEP risk pre- and post-ERCP based on patient factors, procedure indications, findings, and techniques. PEP incidence was assessed with or without PEPX after stratifying risk using a SAFER approach.

Results

From a cohort of 3006 procedures, PEP incidence without any PEPX in all patients with low post-ERCP risk (n = 2096) was 0.2%. Independent of PEPX, there was no significant difference in the incidence of PEP between procedures with both low pre- and post-ERCP risk and those with high pre-ERCP risk but low post-ERCP risk.

Conclusions

To influence PEPX decisions, procedure-related factors may be more important than patient-related PEP risk factors. A SAFER approach suggests that low-risk post-ERCP patients do not need PEPX, although further prospective studies are needed.

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内镜后逆行胰胆管造影预防胰腺炎：一种评估风险的分层评估方法

背景与目的内镜逆行胰胆管造影（ERCP）后发生胰腺炎（PEP）的风险受患者和手术相关因素的影响。降低PEP的策略非常重要。本研究旨在确定在分层风险评估（SAFER）方法指导下避免高危手术相关因素的患者是否可以避免PEP预防（PEPX）。SAFER是一个动态过程，程序相关因素直接影响PEPX策略。方法对连续ercp前瞻性数据库进行分析。收集了有关人口统计学、手术适应症、既往ERCP尝试、插管技术、接受的PEPX和不良事件的数据。每个ERCP根据患者因素、手术指征、结果和技术对ERCP前后PEP风险进行分类。在使用更安全的方法进行风险分层后，评估是否使用PEPX的PEP发生率。结果在3006例手术队列中，所有ercp后低风险患者（n = 2096）无任何PEPX的PEP发生率为0.2%。与PEPX无关，ercp术前和术后低风险的手术与ercp术前和术后高风险但低风险的手术之间PEP的发生率无显著差异。结论手术相关因素可能比患者相关PEP危险因素更重要。一种更安全的方法表明，低风险的ercp后患者不需要PEPX，尽管需要进一步的前瞻性研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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