Borrelli de Andreis Federica, Mascagni Pietro, Schepis Tommaso, Attili Fabia, Tringali Andrea, Costamagna Guido, Boškoski Ivo
First Department of Internal Medicine, Fondazione IRCCS San Matteo Hospital, University of Pavia, Pavia, Italy.
Gastroenterology Unit, Istituti Clinici Maugeri, University of Pavia, Pavia, Italy.
Therap Adv Gastroenterol. 2023 Mar 6;16:17562848231155984. doi: 10.1177/17562848231155984. eCollection 2023.
Endoscopic retrograde cholangiopancreatography (ERCP) is an advanced endoscopic procedure that might lead to severe adverse events. Post-ERCP pancreatitis (PEP) is the most common post-procedural complication, which is related to significant mortality and increasing healthcare costs. Up to now, the prevalent approach to prevent PEP consisted of employing pharmacological and technical expedients that have been shown to improve post-ERCP outcomes, such as the administration of rectal nonsteroidal anti-inflammatory drugs, aggressive intravenous hydration, and the placement of a pancreatic stent. However, it has been reported that PEP originates from a more complex interaction of procedural and patient-related factors. Appropriate ERCP training has a pivotal role in PEP prevention strategy, and it is not a chance that a low PEP rate is universally considered one of the most relevant indicators of proficiency in ERCP. Scant data on the acquisition of skills during the ERCP training are currently available, although some efforts have been recently done to shorten the learning curve by way of simulation-based training and demonstrate competency by meeting technical requirements as well as adopting skill evaluation scales. Besides, the identification of adequate indications for ERCP and accurate pre-procedural risk stratification of patients might help to reduce PEP occurrence regardless of the endoscopist's technical abilities, and generally preserve safety in ERCP. This review aims at delineating current preventive strategies and highlighting novel perspectives for a safer ERCP focusing on the prevention of PEP.
内镜逆行胰胆管造影术（ERCP）是一种先进的内镜检查程序，可能会导致严重的不良事件。ERCP术后胰腺炎（PEP）是最常见的术后并发症，与显著的死亡率和不断增加的医疗费用相关。到目前为止，预防PEP的普遍方法包括采用药理学和技术手段，这些手段已被证明可改善ERCP术后的结果，如直肠给予非甾体类抗炎药、积极的静脉补液以及放置胰管支架。然而，据报道，PEP源于操作相关因素与患者相关因素更为复杂的相互作用。适当的ERCP培训在PEP预防策略中起着关键作用，低PEP发生率被普遍认为是ERCP熟练程度最重要的指标之一并非偶然。目前关于ERCP培训期间技能获取的数据很少，尽管最近已做出一些努力通过基于模拟的培训来缩短学习曲线，并通过满足技术要求以及采用技能评估量表来证明能力水平。此外，确定ERCP的适当适应证以及对患者进行准确的术前风险分层可能有助于减少PEP的发生，而不管内镜医师的技术能力如何，并总体上确保ERCP操作的安全性。本综述旨在阐述当前的预防策略，并突出以预防PEP为重点的更安全ERCP的新观点。
