Post-endoscopic retrograde cholangiopancreatography cholecystitis: A review of incidence, risk factors, prevention, and management.

Post-endoscopic retrograde cholangiopancreatography (ERCP) cholecystitis (PEC) is a recognized adverse event associated with ERCP. The incidence of PEC is low in patients undergoing ERCP, but is high in specific subgroups, such as those receiving fully-covered self-expandable metallic stents (SEMS). Several risk factors contribute to PEC, including gallbladder (GB)-related factors like tumor involvement of the orifice of the cystic duct (OCD) or feeding artery, and associated gallstones. Stent-related factors, such as covered stent placement and high axial force stents, and procedure-related factors, including stent placement across the OCD and contrast injection into the GB, further elevate the risk. Prevention strategies focus on modifying techniques, such as careful contrast administration and stent selection (uncovered or low axial force SEMS), and considering prophylactic GB drainage through endoscopic transpapillary GB drainage (ETGBD) or endoscopic ultrasound-guided GB drainage (EUS-GBD), especially in high-risk patients. Treatment options for PEC range from conservative management with antibiotics to more invasive interventions like percutaneous transhepatic GB aspiration or drainage, endoscopic techniques (ETGBD, EUS-GBD), and cholecystectomy. The choice of treatment depends on the severity of cholecystitis, the patient's condition, and other factors. The present review summarizes the currently available literature on the incidence, predictors, prevention, and management of PEC.