Il danno pancreatico in corso di colangiopancreatografia retrograda endoscopica: Una complicanza prevedibile e prevenibile

Endoscopic retrograde cholangiopancreatography (ERCP) carries a higher potential for complications compared with other endoscopic procedures. Even in expert hands complications are expected to occur in a predictable proportion of patients undergoing ERCP. After reviewing the recent prospective literature, a cumulative rate of pancreatitis of 5.2% for diagnostic ERCP and 4.1% for therapeutic biliary ERCP has emerged. Large- scale multicenter cohort studies, using multivariate analyses, have identified the experience of the endoscopist and some patients' characteristics (younger age and suspected sphincter of Oddi dysfunction together with small duct diameter) as important factors in determining the outcome of ERCP. In this clinical setting, complications seem unavoidable with current technique, even with the proper training of endoscopists. Therefore, research in the prevention of post-ERCP pancreatitis by means of prophylactic administration of drugs in the pre-procedure period must continue. A recent meta-analysis on 28 chemoprevention trials on somatostatin, octreotide, or gabexate-mesilate has shown that both somatostatin and gabexate-mesilate were effective in reducing post-ERCP pain, hyper-amylasemia and pancreatitis, whereas octreotide proved effective only in reducing post-procedural hyper-amylasemia. Several editorial comments have stressed that nowadays it is feasible to make ERCP safer for patients with the prophylactic administration of these two drugs. Currently the question to be answered is how the prophylaxis should be carried out as it seems reasonable to pretreat only certain high-risk groups of patients. A prospective multicenter trial is currently under way in Italy to further test this hypothesis.