“Acute pancreatitis is the most common post-procedural complication following endoscopic retrogrande cholangiopancreatography (ERCP). Its incidence is reported between 2.1% and 24.4%, with such variability being attributable to heterogeneous patient populations, differing levels of endoscopic expertise, procedural differences, disparate definitions of post-ERCP pancreatitis (PEP) and its severity”

“The pathophysiology of PEP is not entirely clear with a multi-factorial concept being held. This involves a combination of chemical, thermal, mechanic, hydrostatic, enzymatic, allergic, and microbiological insults that result from papillary instrumentation and/or hydrostatic injury
from the overfilling of the pancreatic duct with contrast material. The influence of these factors leads to a cascade of events resulting in premature intracellular activation
of pancreatic proteolytic enzymes, autodigestion, and the release of inflammatory cytokines that produce both local and systemic effects.”

“The etiology of PEP is multi-factorial. The pathophysiology has not yet been studied entirely. Patient physiological characteristics and co-morbidities, procedural features, post-procedural factors are influential in the pathogenesis of PEP and may be used to determine the risk of its appearance. The prediction and early identification of PEP is challenging. Despite various diagnostic techniques and different attempts at establishing scoring models of early PEP recognition, they are all flawed and the task of improving risk stratification and early diagnosis is still relevant.”

Tryliskyy Y, et al Post-ERCP pancreatitis: Pathophysiology, early identification and risk stratification. Adv Clin Exp Med. 2018 Jan;27(1):149-154. Free Full Text