Endoscopic retrograde cholangiopancreatography-related complications: risk stratification, prevention, and management

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) plays a crucial role in the management of pancreaticobiliary disorders. Although the ERCP technique has been refined over the past five decades, it remains one of the endoscopic procedures with the highest rate of complications. Risk factors for ERCP-related complications are broadly classified into patient-, procedure-, and operator-related risk factors. Although non-modifiable, patient-related risk factors allow for the closer monitoring and instatement of preventive measures. Post-ERCP pancreatitis is the most common complication of ERCP. Risk reduction strategies include intravenous hydration, rectal nonsteroidal anti-inflammatory drugs, and pancreatic stent placement in selected patients. Perforation is associated with significant morbidity and mortality, and prompt recognition and treatment of ERCP-related perforations are key to ensuring good clinical outcomes. Endoscopy plays an expanding role in the treatment of perforations. Specific management strategies depend on the location of the perforation and the patient’s clinical status. The risk of post-ERCP bleeding can be attenuated by preprocedural optimization and adoption of intra-procedural techniques. Endoscopic measures are the mainstay of management for post-ERCP bleeding. Escalation to angioembolization or surgery may be required for refractory bleeding. Post-ERCP cholangitis can be reduced with antibiotic prophylaxis in high risk patients. Bile culture-directed therapy plays an important role in antimicrobial treatment.

Double-guidewire technique for selective biliary cannulation does not increase the rate of post-endoscopic retrograde cholangiopancreatography pancreatitis in patients with naïve papilla

“…PEP is one of the most common and severe complications of ERCP. [12][13][14] The incidence of PEP ranges from 0.4% to 1.5% in diagnostic ERCP and 1.6% to 5.4% in therapeutic ERCP. 15 It is often clinically mild or moderate in severity; however, in approximately 10% of cases, it is severe and potentially fatal.…”

Computed tomography-based prediction of pancreatitis following biliary metal stent placement with the convolutional neural network

“…Post-ERCP pancreatitis has been associated with substantial morbidity and mortality among patients receiving endoscopic biliary interventions 12 13 ; therefore, a large number of studies have investigated clinical parameters as potential risk factors as well as preventive measures for this procedure-related AE 30 . Risk stratification based on factors related to patients, procedures, and operators would help personalize peri-procedure care for patients receiving the treatment.…”

International Digestive Endoscopy Network consensus on the management of antithrombotic agents in patients undergoing gastrointestinal endoscopy

“…Therefore, we categorized endoscopic papillectomy as an ultra-high-risk procedure. [18][19][20] Regarding colon polypectomies, the PPB rate after cold snare polypectomy (CSP) for colon polyps less than 1 cm in size is less than 1% regardless of the morphology of the colon polyp, and the delayed PPB rate, even when warfarin is used, is reported to be less than 1%. [20][21][22][23][24][25] It would be useful to separately classify CSP for these lesions as a low-risk procedure because polyps less than 1 cm comprise 70% to 90% of detected polyps during colonoscopy.…”