Strategies for Prevention of Endoscopic Retrograde Cholangiopancreatography-induced Pancreatitis with Special Reference to Hydration Therapy

Endoscopic retrograde cholangiopancreatography (ERCP) carries a post-ERCP pancreatitis (PEP) rate of 2%–10%, which can be as high as 30%–50% in high-risk cases. PEP is severe in up to 5% of cases, with potentially life-threatening complications, including peripancreatic fluid collections, multiorgan failure, and even death in up to 1% of cases. The risk of PEP is potentially predictable and can be modified with pharmacological measures and endoscopy. This review covers the risk factors for PEP, with a focus on the preventive strategies that include pharmacotherapy, fluid therapy, and endotherapy. Novel predictors for PEP have also been reviewed.