Treatment strategy for fulminant acute pancreatitis after endoscopic retrograde cholangiopancreatography

The incidence of complications after endoscopic retrograde cholangiopancreatography (ERCP) is reported to be 1% to 15% [4]. Acute post-intervention pancreatitis is a serious complication after endoscopic transpapillary procedures; it is characterized by rapid progression and high mortality rates [8]. In up to 15% of patients, severe acute post-intervention pancreatitis is accompanied by pancreatic necrosis and multiple organ failure [4]. The death rate in sterile pancreatic necrosis varies between 15% and 30%, whereas in infective pancreatic necrosis, the death rate reaches 85% [3, 9]. Intraductal pancreatic hypertension has a crucial importance in the pathogenesis of acute pancreatitis; therefore, early and adequate decompression minimizes the risk of severe parapancreatic complications [1]. Preventive stenting of the main pancreatic duct (MPD) significantly reduced the risk of this complication. However, there is still no consensus on the effectiveness of this preventive measure [7]. The accumulation of collective experience will allow us to develop a unified strategy for patients at risk of acute post-intervention pancreatitis.