3. ERCP Complications

Complications of ERCP

Perforation (<1%)

  • Free bowel wall perforation (25%)
    Requires surgery.

  • Retroperitoneal duodenal (periampullary) perforation (46%)
    Often managed conservatively.

  • Perforated pancreatic duct (PD) or bile duct (BD) (22%)

  • Retroperitoneal air alone (3%)
    e.g., post-sphincterotomy; may not always require intervention.

Pancreatitis (up to 5%)

  • Treatment

    • Bowel rest

    • IV fluids

    • General supportive management, as with other causes of pancreatitis

  • Prophylaxis

    • Strong evidence supports rectal diclofenac or indomethacin

    • BSG Guidelines: Short-term pancreatic duct stenting at ERCP reduces the risk of post-ERCP pancreatitis (PEP) in high-risk patients, including:

      • Younger age

      • Female sex

      • Suspected sphincter of Oddi dysfunction

      • Repeated pancreatic duct cannulation

ERCP Standards

  • Minimum 75 cases per ERCPist (annually)

  • Minimum 150 cases per unit (annually)

Minimum Standards (Based on Intention to Treat)

  1. ≥85% cannulation rate of a virgin papilla

  2. ≥75% CBD stone clearance for those undergoing their first-ever ERCP

  3. ≥80% successful stenting (with cytology or histology) at the first ERCP for patients with an extra-hepatic stricture