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UEG Standards and Guidelines

Clinical Practice Guideline

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Main recommendations

Prophylaxis

1 ESGE recommends routine rectal administration of 100mg of diclofenac or indomethacin immediately before endoscopic retrograde cholangiopancreatography (ERCP) in all patients without contraindications to nonsteroidal antiinflammatory drug administration.

Strong recommendation, moderate quality evidence.

2 ESGE recommends prophylactic pancreatic stenting in selected patients at high risk for post-ERCP pancreatitis (inadvertent guidewire insertion/opacification of the pancreatic duct, double-guidewire cannulation).

Strong recommendation, moderate quality evidence.

3 ESGE suggests against routine endoscopic biliary sphincterotomy before the insertion of a single plastic stent or an uncovered/partially covered self-expandable metal stent for relief of biliary obstruction.

Weak recommendation, moderate quality evidence.

4 ESGE recommends against the routine use of antibiotic prophylaxis before ERCP.

Strong recommendation, moderate quality evidence.

5 ESGE suggests antibiotic prophylaxis before ERCP in the case of anticipated incomplete biliary drainage, for severely immunocompromised patients, and when performing cholangioscopy.

Weak recommendation, moderate quality evidence.

6 ESGE suggests tests of coagulation are not routinely required prior to ERCP for patients who are not on anticoagulants and not jaundiced.

Weak recommendation, low quality evidence.

Treatment

7 ESGE suggests against salvage pancreatic stenting in patients with post-ERCP pancreatitis.

Weak recommendation, low quality evidence.

8 ESGE suggests temporary placement of a biliary fully covered self-expandable metal stent for post-sphincterotomy bleeding refractory to standard hemostatic modalities.

Weak recommendation, low quality evidence.

9 ESGE suggests to evaluate patients with post-ERCP cholangitis by abdominal ultrasonography or computed tomography (CT) scan and, in the absence of improvement with conservative therapy, to consider repeat ERCP. A bile sample should be collected for microbiological examination during repeat ERCP.

Weak recommendation, low quality evidence.

ERCP-related adverse events:European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Jean-Marc Dumonceau

Publisher

European Society of Gastrointestinal Endoscopy

Guideline

Clinical Practice Guideline

Topics

Endoscopy

Citation

Endoscopy. 2020 Feb;52(2):127-149

Published

2019

UEG Podcast Episode

UEG Podcast

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Part 1: Nageshwar Reddy - How endoscopy has changed

Duvvur Nageshwar Reddy, Pradeep Mundre

Topics

Endoscopy

Published

2026

UEG Mistakes In Articles

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Pancreatic cystic neoplasms (PCN) are a frequent and clinically challenging condition. PCN prevalence increases with age and reports estimate that they may be present in 2–45% of the general population. In addition, the biological behaviour of the various types of PCN differs (ranging from benign to malignant [table 1]), requiring different surveillance and therapeutic approaches. Correct management of PCN is, therefore, critical for avoiding progression to cancer, but at the same time avoiding unneeded close and long-term follow-up, unnecessary invasive diagnostic procedures and overtreatment.

Mistakes in pancreatic cystic neoplasms and how to avoid them

Marco Del Chiaro, Juan Enrique Dominguez-Munoz, Giovanni Marchegiani

Topics

Digestive Oncology Pancreas

Citation

Domínguez-Muñoz J.E. and Del Chiaro M. Mistakes in pancreatic cystic neoplasms and how to avoid them. UEG Education 2018; 18: 35–37.

Published

2024

UEG Podcast Episode

UEG Podcast

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From Vienna to Berlin: What inspired us last year at UEG Week

Egle Dieninyte - Misiune, Pradeep Mundre

Published

2025

UEG Podcast Episode

UEG Podcast

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Pancreatic cystic neoplasms with Marco del Chiaro

Marco Del Chiaro, Egle Dieninyte - Misiune

Topics

Pancreas

Published

2025

UEG Standards and Guidelines

Clinical Practice Guideline

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Abstract

Pancreatic exocrine insufficiency (PEI) is defined as a reduction in pancreatic exocrine secretion below the level that allows the normal digestion of nutrients. Pancreatic disease and surgery are the main causes of PEI. However, other conditions and upper gastrointestinal surgery can also affect the digestive function of the pancreas. PEI can cause symptoms of nutritional malabsorption and deficiencies, which affect the quality of life and increase morbidity and mortality. These guidelines were developed following the United European Gastroenterology framework for the development of high-quality clinical guidelines. After a systematic literature review, the evidence was evaluated according to the Oxford Center for Evidence-Based Medicine and the Grading of Recommendations Assessment, Development, and Evaluation methodology, as appropriate. Statements and comments were developed by the working groups and voted on using the Delphi method. The diagnosis of PEI should be based on a global assessment of symptoms, nutritional status, and a pancreatic secretion test. Pancreatic enzyme replacement therapy (PERT), together with dietary advice and support, are the cornerstones of PEI therapy. PERT is indicated in patients with PEI that is secondary to pancreatic disease, pancreatic surgery, or other metabolic or gastroenterological conditions. Specific recommendations concerning the management of PEI under various clinical conditions are provided based on evidence and expert opinions. This evidence-based guideline summarizes the prevalence, clinical impact, and general diagnostic and therapeutic approaches for PEI, as well as the specifics of PEI in different clinical conditions. Finally, the unmet needs for future research are discussed.

European guidelines for the diagnosis and treatment of pancreatic exocrine insufficiency: UEG, EPC, EDS, ESPEN, ESPGHAN, ESDO, and ESPCG evidence-based recommendations

Juan Enrique Dominguez-Munoz

Publishers

European Society for Primary Care Gastroenterology, European Society of Digestive Oncology, European Society for Paediatric Gastroenterology, Hepatology and Nutrition, The European Society for Clinical Nutrition and Metabolism, European Digestive Surgery, European Pancreatic Club