Delayed Onset Post-ERCP Pancreatitis (DOPE-P)

Vishal Khurana*

Delayed Onset Post-ERCP Pancreatitis.

Post Endoscopic retrograde cholangiopancreatography Pancreatitis is defined as new onset or worsening of pain abdomen after ERCP with an elevation of pancreatic enzymes more than 3 times upper limit of normal after 24 hours of procedure and prolongation of hospital
stay/planned admission.

Placement of prophylactic pancreatic stents usually advocated in high-risk patients and reduced PEP rate by 60-80%. Fr stents have higher migration rate and hence
5 Fr stents are superior to 3 Fr. Studies have shown that if placement of pancreatic stent is attempted but fails risk of PEP increases.

There is scarce data available on incidence and severity of delayed onset post ERCP pancreatitis (DOPE-P). DOPE-P
is defined as the development of features of pancreatitis after the
first 24 hrs of ERCP.

It can occur in two situations: either early migration of prophylactic pancreatic duct
stent within first day of ERCP or after endoscopic removal of PD stent. A retrospective cohort study of 230 patient undergoing
PPS removal
has shown 3% incidence of pancreatitis after pancreatic stent removal. Statistical significant risk factors found in this study were
use of 5 fr a stent, stent with internal flange and history of PEP after
initial ERCP.

There is a need for a prospective trial for incidence, severity and prevention of DOPE-P. Judicious
use of PPS in the only high-risk ERCP with slow removal of PPS
within 5-10 days or pharmacoprophylaxis with rectal Nonsteroidal antiinflammatory drug, if stent removal done after
10 days, it may theoretically decrease the incidence of
DOPE-P. Guidelines
recommends evaluation of self-migration of PPS within 5-10 days
of placement and endoscopic removal if stent do not migrate with
5-10 days.

Pancreas Open J. 2018; 2(1): e8-e9. doi: 10.17140/POJ-2-e008