Gastroenterology Service, Hôpital Civil Marie Curie, Charleroi, Belgium.
Department of Gastroenterology and Hepatology, Ordensklinikum Barmherzige Schwestern, Linz, Austria.
Endoscopy. 2020 Feb;52(2):127-149. doi: 10.1055/a-1075-4080. Epub 2019 Dec 20.
1: ESGE recommends routine rectal administration of 100 mg of diclofenac or indomethacin immediately before endoscopic retrograde cholangiopancreatography (ERCP) in all patients without contraindications to nonsteroidal anti-inflammatory drug administration.Strong recommendation, moderate quality evidence. 2: ESGE recommends prophylactic pancreatic stenting in selected patients at high risk for post-ERCP pancreatitis (inadvertent guidewire insertion/opacification of the pancreatic duct, double-guidewire cannulation).Strong recommendation, moderate quality evidence. 3: ESGE suggests against routine endoscopic biliary sphincterotomy before the insertion of a single plastic stent or an uncovered/partially covered self-expandable metal stent for relief of biliary obstruction.Weak recommendation, moderate quality evidence. 4: ESGE recommends against the routine use of antibiotic prophylaxis before ERCP.Strong recommendation, moderate quality evidence. 5: ESGE suggests antibiotic prophylaxis before ERCP in the case of anticipated incomplete biliary drainage, for severely immunocompromised patients, and when performing cholangioscopy.Weak recommendation, moderate quality evidence. 6: ESGE suggests tests of coagulation are not routinely required prior to ERCP for patients who are not on anticoagulants and not jaundiced.Weak recommendation, low quality evidence.
7: ESGE suggests against salvage pancreatic stenting in patients with post-ERCP pancreatitis.Weak recommendation, low quality evidence. 8: ESGE suggests temporary placement of a biliary fully covered self-expandable metal stent for post-sphincterotomy bleeding refractory to standard hemostatic modalities.Weak recommendation, low quality evidence. 9: ESGE suggests to evaluate patients with post-ERCP cholangitis by abdominal ultrasonography or computed tomography (CT) scan and, in the absence of improvement with conservative therapy, to consider repeat ERCP. A bile sample should be collected for microbiological examination during repeat ERCP.Weak recommendation, low quality evidence.
对于无非甾体抗炎药使用禁忌的所有患者，ESGE 建议在进行内镜逆行胰胆管造影术（ERCP）前，常规直肠给予 100mg 双氯芬酸或吲哚美辛。强烈推荐，中等质量证据。
ESGE 建议对有发生 ERCP 后胰腺炎（导丝意外插入/胰管显影、双导丝插管）高危风险的患者，预防性胰腺支架置入。强烈推荐，中等质量证据。
ESGE 建议对于缓解胆道梗阻，不常规行内镜下胆道括约肌切开术，除非即将插入单根塑料支架或无覆盖/部分覆盖自膨式金属支架。弱推荐，中等质量证据。
ESGE 建议 ERCP 前不常规使用抗生素预防。强烈推荐，中等质量证据。
ESGE 建议对于预计不完全胆道引流、严重免疫功能低下患者以及进行胆管镜检查时，ERCP 前应使用抗生素预防。弱推荐，中等质量证据。
ESGE 建议对于未接受抗凝治疗且无黄疸的患者，ERCP 前无需常规进行凝血检查。弱推荐，低质量证据。
ESGE 建议对于 ERCP 后胰腺炎患者，不进行挽救性胰腺支架置入。弱推荐，低质量证据。
ESGE 建议对于括约肌切开术后出血，在标准止血方法无效时，临时放置胆道全覆膜自膨式金属支架。弱推荐，低质量证据。
ESGE 建议对于 ERCP 后胆管炎患者，通过腹部超声或计算机断层扫描（CT）进行评估，如果在保守治疗后无改善，考虑再次进行 ERCP。在重复 ERCP 时，应收集胆汁样本进行微生物检查。弱推荐，低质量证据。
