ERCP complications: Risk factors and prophylaxis

Among many interventional endoscopic procedures, the Endoscopic Retrograde Cholangiopancreatography (ERCP) carries the highest risk for morbidity and mortality. After reviewing the recent Literature data on this topic, it emerges that main prognostic factors for developing complications after ERCP are the presence of undilated bile ducts, young age of patients, a previous episode of acute pancreatitis, the endoscopist's experience, and the execution of the pre-cut techniques. The single category of patients at risk are those under evaluation for a sphincter of Oddi's dysfunction. A recent Italian clinical trial and a meta-analysis have both confirmed the valne of prophylactic use of gabexate-mesilate in the prevention of post-ERCP complications. However, before the suggestion the general use of this drug can be issued, more data on the cost-benefit analysis are needed. In the meantime, it seems rationale to restrict its use only to patients with undilated bile ducts at time of endoscopy. For all the other cases monitoring of the patients after ERCP is the only valuable recommendation.