Adverse outcomes of endoscopic retrograde cholangiopancreatography

Endoscopic retrograde cholangiopancreatography (ERCP) has evolved from a diagnostic tool into a primarily therapeutic procedure for a variety of biliary and pancreatic problems. ERCP can, however, cause a wide range of short-term complications, including pancreatitis, hemorrhage, and perforation. In general, complications appear to be associated primarily with patient-related factors and the technical skill of the endoscopist. Overall, the risk factors for complications include suspected sphincter of Oddi dysfunction and technique-related variables, such as difficult cannulation, precut sphincterotomy in inexperienced hands, failure to achieve drainage, and percutaneous transhepatic biliary access. Reviewed here are specific risk factors for post-ERCP pancreatitis and hemorrhage. A risk-factor assessment may be useful to help the endoscopist decide whether or not to perform ERCP and aids in making decisions regarding the techniques to be used. The principal strategies to reduce complications of ERCP include improving the training and education of endoscopists regarding risk factors; avoiding marginally indicated ERCP and preferentially using alternative imaging techniques; making referrals to advanced centers for complex or high-risk cases; and, in due course, concentrating ERCP practices among fewer endoscopists performing more ERCPs.