Christoforidis et al evaluated patients who developed pancreatitis following endoscopic retrograde cholangiopancreatography (ERCP). The authors are from Aristotelian University of Thessaloniki in Greece.


Criteria for post-ERCP pancreatitis:

(1) epigastric pain radiating to the back, abdominal tenderness and/or other features of pancreatic-type abdominal pain

(2) onset following an ERCP and persisting for >= 24 hours

(3) elevation of the serum amylase 4-5 times the upper limit of the normal reference range



• The serum amylase prior to the ERCP is not used to reference the rise.


An elevation of the serum amylase without physical complaints constitutes hyperamylasemia.


Risk factors for pancreatitis:

(1) age < 50 years

(2) history of relapsing pancreatitis

(3) difficulty in cannulating the bile duct during the procedure

(4) if the pancreatic duct is cannulated (done only if there were reasons to do so), presence of Grade B opacification (visualization of the main pancreatic duct and its primary branches)


Factors that reduced the risk of developing pancreatitis:

(1) sphincterotomy

(2) performing additional procedures (stone extraction, stent placement, brush cytology, etc)


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