Incidência de Pancreatite Aguda em Pacientes no Pós-operatório de CPRE: Uma Revisão Sistemática

Abstract

Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) is widely used in the diagnosis and treatment of pancreatobiliary disorders but carries a substantial risk of complications, with post-endoscopic retrograde cholangiopancreatography acute pancreatitis (PAPCRE) being the most common and clinically significant. Objective: To systematically evaluate the incidence, risk factors, and preventive strategies for PAPCRE based on evidence published between 2000 and 2025. Methods: This systematic review followed the PRISMA 2020 guidelines. Searches were conducted in PubMed, Scopus, and Google Scholar using the keywords “post-ERCP pancreatitis,” “incidence,” “risk factors,” and “prevention.” Systematic reviews, meta-analyses, and observational studies reporting quantitative data on the incidence, severity, and mortality of PAPCRE were included. Results: The pooled incidence ranged from 4% to 10%, reaching up to 14% among high-risk patients. Severe cases accounted for approximately 0.5%, with a mean mortality rate of 0.2%. Identified risk factors included female sex, sphincter of Oddi dysfunction, difficult cannulation, multiple cannulation attempts, and inadvertent pancreatic duct injection. Preventive strategies such as rectal administration of nonsteroidal anti-inflammatory drugs (NSAIDs), aggressive periprocedural hydration with lactated Ringer’s solution, and temporary pancreatic stent placement were shown to significantly reduce the risk of PAPCRE. Recent international guidelines (ESGE, 2023) and meta-analyses published between 2020 and 2023 reinforce the importance of these combined preventive measures. Conclusion: PAPCRE remains a common but largely preventable complication. The adoption of standardized, evidence-based protocols, technical training, and the systematic application of pharmacological and mechanical prophylaxis are crucial to minimizing the incidence, severity, and healthcare burden associated with post-ERCP pancreatitis.