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Abstract
Based on the previous study and results, the following is recommended 1- Guide-wire cannulation of the bile duct before contrast injection is a safe and effective method for prevention of post-ERCP pancreatitis.
This approach prevents accidental injection of contrast medium into the main pancreatic duct or the papilla itself (submucosal injection) and, thereby, reduces the possibility of chemical- and pressure-related pancreatic injury.
Insertion of a double-channel papillotome over the guide-wire allows easier and faster cannulation, with little trauma to the papilla, so that the risk of pancreatitis is minimized even in patients at increased risk for this complication.
So that, Guide-wire technique for bile duct cannulation lowers likelihood of post-ERCP pancreatitis by facilitating cannulation and reducing need for precut sphincterotomy.2- Guide-wire cannulation can be used as routine method for any patient in need for diagnostic or therapeutic ERCP, so that no need for routine methods of cannulation for patients with high risk factors for post-ERCP pancreatitis as done before in some communities, these method provide a simple, inexpensive, accurate, and non-invasive means for individuals with high risk factors for post-ERCP pancreatitis.3- This study emphasizes the role of patient factors (age, female gender, prior history of post-ERCP pancreatitis) and technical factors (number of PD injections, amount of contrast agent, difficulty of cannulation, dilated CBD 8mm diameter, number of papilla cannulation, duration of ERCP, papilla sphincterotomy, and operator experience) as the determining high-risk predictors for post-ERCP pancreatitis 4- Methods of preventing post-ERCP pancreatitis have been sought for many years and numerous drugs have been tried using a variety of regimes with heterogeneous groups of patients. At present study a good hydration and N-Acetylcysteine in ERCP as a preparation to avoid post-ERCP pancreatitis and renal dysfunction which looks to be the most efficacious prophylactic method. It is possible, however, by using a simple strategy to minimize the incidence of post-ERCP pancreatitis and modulate its severity and complications.5- Good training for the beginner endoscopist. It is possible, however, by using a simple strategy to minimize the incidence of post-ERCP pancreatitis and modulate its severity. As experience of endoscopist has a role in prevention of the post-ERCP pancreatitis 6- Early ERCP interventions, as we can select the patient who needs endoscopy therapy and follow up, to avoid complications of ERCP delay, especially when this procedure is not readily available in smaller communities 7- Early detection of post ERCP pancreatitis and early management has a role in prevention the deterioration of patient condition and avoid bad sequels of pancreatitis especially end organ failure caused by systemic inflammatory response 8- Further studies on larger group of patients are recommended to study the specificity and sensitivity of these parameters in prediction and avoid of post-ERCP renal dysfunction in patients with different high risk factors.