Endoscopic retrograde cholangiopancreatography (ERCP) was initially introduced as a diagnostic procedure,
but this indication was mostly abandoned because of its invasive nature and significant rate of complications.
It remains a firmly established therapeutic modality for pancreatic and biliary disorders,
and can often obviate the need for surgery.
The incidences of adverse events are reported as 5% to 10%,
depending on the complexity of the procedure,
the underlying diagnosis,
and patient co-morbidities.1,2 Some of the complications are related to endoscopy,
such as perforation,
bleeding,
and issues with sedation.
However,
there are unique complications secondary to ductal manipulation,
such as acute pancreatitis,
cholangitis,
and cholecystitis.
Understanding of complications of ERCP has progressed substantially in the past decades,
following widespread adoption of standardized consensus-based definitions.
Severity is assessed primarily by length of hospital stay,
and treatment required.3 As for the timing,
complications are considered immediate if they occur during or shortly after the procedure,
early if they occur within a few hours,
and delayed if they occur within 30 days.4
The most common occurrence is pancreatitis.
Another complication to consider is perforation,
both of the duodenal wall and of the ducts.
These are the most frequent causes of post-procedural pain,
and their initial clinical presentation is very similar,
with pain and an elevated serum amylase level.4,5
An early iatrogenic complication should be suspected if the patient is acutely ill within hours or days after the procedure.
CT is the most effective examination to detect and grade these complications,
being able to reliably distinguish between pancreatitis and duodenal perforation,
or suggest a different diagnosis.4–6
Delayed complications include mainly infections associated with indwelling stents and inflammatory changes secondary to ductal manipulation.