Endoscopy 2020; 52(02): 127-149
DOI: 10.1055/a-1075-4080
Guideline
© Georg Thieme Verlag KG Stuttgart · New York

ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Jean-Marc Dumonceau
 1  Gastroenterology Service, Hôpital Civil Marie Curie, Charleroi, Belgium
,
Christine Kapral
 2  Department of Gastroenterology and Hepatology, Ordensklinikum Barmherzige Schwestern, Linz, Austria
,
Lars Aabakken
 3  GI Endoscopy Unit, OUS, Rikshospitalet University Hospital, Oslo, Norway
,
Ioannis S. Papanikolaou
 4  Hepatogastroenterology Unit, Second Department of Internal Medicine – Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University, Attikon University General Hospital, Athens, Greece
,
Andrea Tringali
 5  Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
 6  Centre for Endoscopic Research, Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, Rome, Italy
,
Geoffroy Vanbiervliet
 7  Centre Hospitalier Universitaire de Nice, Pole D.A.R.E, Endoscopie Digestive, Nice, France
,
Torsten Beyna
 8  Department of Internal Medicine and Gastroenterology, Evangelisches Krankenhaus Düsseldorf, Dusseldorf, Germany
,
Mario Dinis-Ribeiro
 9  Gastroenterology Department, Portuguese Oncology Institute of Porto, Portugal
10  Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, Porto, Portugal
,
Istvan Hritz
11  Semmelweis University, 1st Department of Surgery, Center for Therapeutic Endoscopy, Budapest, Hungary
,
Alberto Mariani
12  Division of Pancreato-Biliary Endoscopy and Endosonography, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita Salute San Raffaele University, Milan, Italy
,
Gregorios Paspatis
13  Gastroenterology Department, Benizelion General Hospital, Heraklion, Crete, Greece
,
Franco Radaelli
14  Gastroenterology Department, Valduce Hospital, Como, Italy,
,
Sundeep Lakhtakia
15  Asian Institute of Gastroenterology, Hyderabad, India
,
Andrew M. Veitch
16  Department of Gastroenterology, New Cross Hospital, Wolverhampton, UK
,
Jeanin E. van Hooft
17  Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands
› Author Affiliations
Further Information

Publication History

Publication Date:
20 December 2019 (online)

Main Recommendations

Prophylaxis

1 ESGE recommends routine rectal administration of 100 mg of diclofenac or indomethacin immediately before endoscopic retrograde cholangiopancreatography (ERCP) in all patients without contraindications to nonsteroidal anti-inflammatory drug administration.

Strong recommendation, moderate quality evidence.

2 ESGE recommends prophylactic pancreatic stenting in selected patients at high risk for post-ERCP pancreatitis (inadvertent guidewire insertion/opacification of the pancreatic duct, double-guidewire cannulation).

Strong recommendation, moderate quality evidence.

3 ESGE suggests against routine endoscopic biliary sphincterotomy before the insertion of a single plastic stent or an uncovered/partially covered self-expandable metal stent for relief of biliary obstruction.

Weak recommendation, moderate quality evidence.

4 ESGE recommends against the routine use of antibiotic prophylaxis before ERCP.

Strong recommendation, moderate quality evidence.

5 ESGE suggests antibiotic prophylaxis before ERCP in the case of anticipated incomplete biliary drainage, for severely immunocompromised patients, and when performing cholangioscopy.

Weak recommendation, moderate quality evidence.

6 ESGE suggests tests of coagulation are not routinely required prior to ERCP for patients who are not on anticoagulants and not jaundiced.

Weak recommendation, low quality evidence.

Treatment

7 ESGE suggests against salvage pancreatic stenting in patients with post-ERCP pancreatitis.

Weak recommendation, low quality evidence.

8 ESGE suggests temporary placement of a biliary fully covered self-expandable metal stent for post-sphincterotomy bleeding refractory to standard hemostatic modalities.

Weak recommendation, low quality evidence.

9 ESGE suggests to evaluate patients with post-ERCP cholangitis by abdominal ultrasonography or computed tomography (CT) scan and, in the absence of improvement with conservative therapy, to consider repeat ERCP. A bile sample should be collected for microbiological examination during repeat ERCP.

Weak recommendation, low quality evidence.

Supplementary material