Overview of ERCP Complications: Prevention and Management

Adverse events/complications are not uncommon with ERCP. Complications include post-ERCP pancreatitis, bleeding, perforation, cardiopulmonary complications, cholecystitis, and others. Diagnostic ERCP should be avoided. Prophylactic pancreatic duct stents reduce risk of post-ERCP pancreatitis of all degrees of severity in high-risk and mixed-risk patients. Rectal indomethacin independently reduces risk of post-ERCP pancreatitis and may have an additive effect to pancreatic stenting. Hemorrhage is largely a function of coagulation status and technique; perforation is almost entirely technique related. Recognition of risk factors and risk modification is key. Any adverse event should be recognized early and endoscopic management is central to management of hemorrhage and perforation. Appropriate supportive and interventional therapy should be initiated to minimize sequelae of complications.