112 Refining ERCP Techniques Through Approaches to Mitigate Post-ERCP Pancreatitis – Lessons Learnt From 3323 Consecutive Procedures

Abstract Aim Endoscopic Retrograde Cholangiopancreatography (ERCP) is a crucial, yet complex therapeutic procedure, with Post-ERCP Pancreatitis (PEP) being an impactful complication. PEP prevention remains a key consideration, as advised through guidelines from gastrointestinal societies. This study highlights key technical aspects of a surgical ERCP practice, which are instrumental in reducing PEP. Method Our multidisciplinary team included: 4 surgical endoscopists (experience ranging from 30 years’+(A) to 4-years (D)), anaesthetists, endoscopy and support staff. A uniform technical protocol was applied with the following elements:Propofol sedation and careful peri-procedural fluid balanceShort-position endoscope handling – stable and precise cannulation.Minimal papillary contact - 20 mg IV Buscopan (±1 mg IV Glucagon) to reduce duodenal motility.Guidewire-assisted cannulation – contrast was not injected unless bile was aspirated; no prophylactic pancreatic stenting used.Early needle-knife sphincterotomy – prevent traumatic cannulation attempts.Sphincterotomy at 11 o’clock – anatomically optimal.Post-procedural rectal diclofenac (100 mg) unless contraindicated. Results A prospective data collection and analysis of 3323 consecutive and mixed complexity of cases performed in our centre from September 2016 to May 2025. Individual endoscopist’s caseload was A: 1275, B: 336 (Retired), C: 1294 and D: 418, yearly >130 and as a group > 380. Analysis revealed an overall PEP rate of 2.74% (A: 2.6%, B: 2.7%, C: 3.2%, D: 1.9%) Conclusions Meticulous adherence to a technically refined ERCP protocol can deliver a low rate of post-ERCP pancreatitis. A broader adoption of precision-focused strategies over routine practice will achieve excellence in centres with high expertise.