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Role of ERCP in Patients With Idiopathic Recurrent Acute Pancreatitis

  • Pancreas (T Stevens, Section Editor)
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Opinion statement

Recurrent acute pancreatitis (RAP) is defined based on the occurrence of two or more episodes of acute pancreatitis. RAP is differentiated from chronic pancreatitis based on the presence of a normal morphological appearance of the pancreas between episodes. RAP can be due to a variety of etiologies including common bile duct stones or sludge, sphincter of Oddi dysfunction (SOD), pancreas divisum (PD), anomalous pancreaticobiliary junction, genetic mutations, and alcohol related. In approximately 30 % of patients, the etiology of RAP is unclear and the term “idiopathic” is used. Endoscopic retrograde cholangiopancreatography (ERCP) can be utilized in both the diagnosis and the initial management of RAP, but it has known limitations and risks. Since gallbladder sludge and SOD account for most cases with RAP, cholecystectomy and, eventually, endoscopic biliary and/or pancreatic sphincterotomy are performed as a part of management. In patients with PD-associated RAP, data from uncontrolled and primarily retrospective studies point toward a benefit from minor papillary endoscopic intervention. However, given the lack of quality data from prospective randomized controlled trials (RCTs), endoscopic management in such patients remains an individualized decision, and RCTs are needed to ascertain its true long-term benefit. Future studies to investigate the role of endoscopic therapy in preventing progression to chronic pancreatitis are needed.

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Abbreviations

AP:

Acute pancreatitis

BES:

Biliary endoscopic sphincterotomy

CFTR:

Cystic fibrosis transmembrane conductance regulator

CP:

Chronic pancreatitis

DES:

Dual endoscopic sphincterotomy

EUS:

Endoscopic ultrasound

ERCP:

Endoscopic retrograde cholangiopancreatography

MRCP:

Magnetic resonance cholangiopancreatography

PEP:

Post-ERCP pancreatitis

PD:

Pancreas divisum

RAP:

Recurrent acute pancreatitis

RCT:

Randomized controlled trial

SOD:

Sphincter of Oddi

SOM:

Sphincter of Oddi manometry

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  1. Center for Interventional Endoscopy, University of Central Florida College of Medicine, Florida Hospital, 601 E Rollins Street, Orlando, FL, 32803, USA

    Piyush Somani MD & Udayakumar Navaneethan MD

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  1. Piyush Somani MD
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Piyush Somani declares no conflict of interest.

Udayakumar Navaneethan is a consultant for AbbVie, Janssen, and Takeda.

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This article is part of the Topical Collection on Pancreas

Specific author contributions: study concept and paper preparation—P Somani. Study concept, design, and critical revisions—U Navaneethan

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MD, P.S., MD, U.N. Role of ERCP in Patients With Idiopathic Recurrent Acute Pancreatitis. Curr Treat Options Gastro 14, 327–339 (2016). https://doi.org/10.1007/s11938-016-0096-9

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