Post-ERCP pancreatitis is the most common and clinically significant complication of endoscopic retrograde cholangiopancreatography (ERCP). Despite advances in technique and guideline-based prevention, it remains a major cause of morbidity, prolonged hospitalization, and healthcare costs. This dissertation shows that post-ERCP pancreatitis occurs in approximately one in ten patients and in nearly one in seven high-risk patients. Severe disease and mortality are uncommon, yet carry substantial clinical impact. The findings demonstrate that the risk of post-ERCP pancreatitis varies widely between patients and procedures and that preventive strategies are not equally effective for everyone. Should all patients therefore receive the same prophylaxis? Probably not. This work shows that a risk-stratified and combined preventive approach results in fewer complications and avoids unnecessary interventions. As in many areas of medicine, individualized care proves superior to a one-size-fits-all strategy.
Akshintala (1987) obtained his medical degree from Andhra Medical College, India. He completed training in internal medicine at the University of Pittsburgh and fellowship training in gastroenterology, followed by advanced fellowships in therapeutic endoscopy and medical pancreatology at Johns Hopkins University. He is currently an Associate Professor of Medicine and faculty member at the Malone Center for Engineering in Healthcare.