Mukai Shuntaro, Takeyama Yoshifumi, Itoi Takao, Ikeura Tsukasa, Irisawa Atsushi, Iwasaki Eisuke, Katanuma Akio, Kitamura Katsuya, Takenaka Mamoru, Hirota Morihisa, Mayumi Toshihiko, Morizane Toshio, Yasuda Ichiro, Ryozawa Shomei, Masamune Atsushi
Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.
Department of Surgery, Osaka Gyoumeikan Hospital, Osaka, Japan.
Dig Endosc. 2025 Jun;37(6):573-587. doi: 10.1111/den.15004. Epub 2025 Mar 25.
The Clinical Practice Guidelines for post-ERCP pancreatitis (PEP) 2023 provide updated recommendations for the prevention, diagnosis, and management of PEP. Endoscopic retrograde cholangiopancreatography (ERCP), a valuable procedure for diagnosing and treating pancreatobiliary diseases, can result in PEP as the most common adverse event. Since the first guidelines were published in 2015, advances in techniques and new research findings have necessitated this revision. The guidelines developed using the GRADE methodology target adult patients undergoing ERCP. They offer a comprehensive framework for clinicians to minimize the risk of PEP. For high-risk patients, endoscopic ultrasound before ERCP is recommended to avoid unnecessary procedures. The guidelines also discuss procedural and patient-related risk factors for PEP, highlighting that operator experience does not significantly affect PEP rates if performed under the supervision of skilled endoscopists. The diagnostic criteria include monitoring serum pancreatic enzyme levels postprocedure, and early computed tomography is advised in suspected cases. For treatment, the guidelines recommend following acute pancreatitis protocols. Key preventive measures include the use of temporary pancreatic duct stents and rectal nonsteroidal anti-inflammatory drugs, both of which are supported by strong evidence for reducing the incidence of PEP. Overall, these guidelines aim to enhance clinical outcomes by reducing PEP incidence and improving its management through evidence-based practices.
《2023年内镜逆行胰胆管造影术后胰腺炎（PEP）临床实践指南》为PEP的预防、诊断和管理提供了最新建议。内镜逆行胰胆管造影术（ERCP）是诊断和治疗胰胆疾病的一项重要检查，但可导致PEP这一最常见的不良事件。自2015年首次发布指南以来，技术进步和新的研究结果使得本次修订成为必要。采用GRADE方法制定的这些指南针对接受ERCP的成年患者。它们为临床医生提供了一个全面的框架，以尽量降低PEP的风险。对于高危患者，建议在ERCP前进行内镜超声检查，以避免不必要的操作。指南还讨论了PEP的操作和患者相关风险因素，强调如果在熟练内镜医师的监督下进行操作，术者经验对PEP发生率没有显著影响。诊断标准包括术后监测血清胰酶水平，疑似病例建议早期进行计算机断层扫描。对于治疗，指南建议遵循急性胰腺炎的治疗方案。关键预防措施包括使用临时胰管支架和直肠非甾体抗炎药，两者均有强有力的证据支持可降低PEP的发生率。总体而言，这些指南旨在通过降低PEP发生率并通过循证实践改善其管理来提高临床结局。
