Prevention of severe post-ERCP pancreatitis? It is possible.

Abstract

Background and Objectives: The main issue of post-endoscopy pancreatitis (PEP) prevention remains an urgent and still an un-solved problem. Despite the relatively low incidence of severe pancreatitis development, treatment costs and mortality rates remain unreasonably high. The purpose of this article is to evaluate the author’s technique for preventing severe PEP progression based on their personal experience. Methods: The study was conducted in a double-centered randomized setting in 836 patients with pancreatobiliary pathology who underwent endoscopic retrograde cholangiopancreatography (ERCP) and/or endoscopic papillosphincterotomy (EPST) from 2016 to 2023. All patients were divided into 4 groups. Group 1 (341 patients) received conventional therapy consisting of medications and the use of a guidewire. Group 2 (100 patients) received a submucosal 10 ml saline injection postbulbar blockade (PBB) (“fake”) in addition to standard premedication. Standard premedication and one “true” PBB with lidocaine or procaine were given to Group 3 (252 patients) upon the completion of the interventions. Group 4 consisted of 143 patients who were given standard premedication and a “true” double PBB (DPBB)—before and after the manipulation itself. Results: The evaluation of PBB’s effectiveness was improved through the development of the DPBB technique. DPBB’s effectiveness in PEP prophylaxis was demonstrated through the absence of severe PEP cases. The benefits of PBB and DPBB were not only rapid pain relief, but also prevention of post-papillotomy bleeding. Regardless of the method used for PEP prophylaxis, hyperamylasemia regression was longer with the use of plastic stents. The average admission period for patients after DPBB was 11.3 ± 1.2 days, which was significantly shorter than in other groups. Conclusion: DPBB was proven to be the most straightforward, simple, and effective technique for severe PEP prophylaxis in comparison with PBB and conventional methods.