ERCP ADVERSE EVENTS: RARE CASES

Aims Adverse events in ERCP are relatively rare (2,5-8%) but often life threatening. Many guidelines are published in order to minimize complication rate. Still some adverse events are hard to predict and prevent. The aim of the study was to analyze the ERCP complication rate and pay attention to rare ones.

Methods From the period from 2013 to 2019 1080 ERCPs were done. As pancreatitis prophylaxis octriotide infusion was performed before and after manipulation. Pancreatic stent placement was performed in cases of multiple pancreatic duct cannulation. Diclofenac per rectum as a hospital standard of care was started from the beginning of 2019, results were not included.

Results We experienced 41 complications (3,8 %), the most frequent complication was pancreatitis with or without subsequent necrosis (n=12, 1,1%). Bleeding after papillotomy occurred in 11 cases (26,8 %), in 9 (81,8%) cases endoscopic hemostasis was effective. Perforations happened in 7 cases (0,65%). In 2 cases endoscopic closure by clips with biliary duct stenting was effective. Two infrequent perforations occured. Once perforation of the bulbus duodeni occurred after the duodenoscope dislocation, no information in the literature of such type of perforation was found. In one case common bile duct (CBD) perforation by the guidewire was found 2 days after the procedure with no leak signs on control X-ray. Subcapsular hematoma occurred in patient after postcholecystectomy CBD stricture bouginage with sudden dislocation of bougie. Remarkably, contrast leakage on fluoroscopy during the procedure was found on the left lobe but hematoma 14,4х4,0х4,8 cm in size visualized in the right liver lobe. Patient was treated conservatively and discharged after organization of hematoma.

Conclusions Even experienced team in big hospital should be ready to manage not only common complications but also with rare ones. Attention and postprocedural patient monitoring play a critical role as well as multidiscipline communication in patient management.