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Post-ERCP pancreatitis prevention — ESEGH MCQ

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ModerateEndoscopyPost-ERCP pancreatitis preventionESEGH

A 44-year-old woman with previous post-ERCP pancreatitis requires ERCP for a confirmed common bile duct stone. She has normal renal function and no NSAID allergy. The pancreatic duct is inadvertently cannulated twice during the procedure. What is the most appropriate management?

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Correct answer: C — Rectal diclofenac or indometacin with consideration of prophylactic pancreatic duct stenting

Rectal NSAIDs reduce post-ERCP pancreatitis risk, and pancreatic duct stenting is considered in high-risk cases such as repeated pancreatic duct cannulation. Antibiotics prevent selected infectious complications, not pancreatitis. Opioids treat pain but do not prevent pancreatitis. The pearl is that post-ERCP pancreatitis prevention should be planned before and during the procedure.

Reference: ESGE ERCP-related Adverse Events Guideline; BSG ERCP Guidance