COMPLICATIONS OF ERCP: Experience of a Center

Aims Endoscopic retrograde cholangiopancreatography (ERCP) is one of the major therapeutic advances in biliopancreatic endoscopy. Today, ERCP is primarily used for therapeutic purposes due to the development of less invasive imaging methods. Assessing the risks and complications of this technique is essential for prevention. The aim of our study was to evaluate the complications of ERCP in our practice.

Methods This was a retrospective, monocentric study conducted over a period of six years, from January 2019 to October 2024. The study included all patients who underwent ERCP and subsequently developed a procedure-related complication. It is noteworthy that all patients systematically received a 100 mg diclofenac suppository prior to the procedure.

Results Out of 793 ERCPs performed, 38 patients (4.8%) experienced complications related to the procedure. The average age was 54 years, with a range from 18 to 91 years. Among these patients, 24 were female (63%) and 14 male (37%), with a sexratio M/F of 0.58. Initial clinical symptoms were primarily cholestatic jaundice in 20 patients (52%), followed by hepatic colic in 11 patients (29%) and pancreatic-type pain in 7 patients (19%).The indications for ERCP in these patients included: common bile duct stones in 15 cases (39.5%), pancreatic head adenocarcinoma in 10 cases (26.3%), cholangiocarcinoma in 6 cases (15.8%), biliary tract trauma in 3 patients (7.9%), a ruptured hepatic hydatid cyst in 2 patients (5.3%), portal biliopathy in one case (2.6%), and compressive liver metastasis in another case (2.6%).ERCP-related complications were as follows: cholangitis in 14 patients (1.8%), significant bleeding at the sphincterotomy site requiring hemostasis in 13 patients (1.6%), post-ERCP acute pancreatitis in 10 patients (1.3%), and a single case of accidental guidewire passage into the portal vein (0.1%). The average hospital stay was 12.4 days. Overall outcomes were favorable, except for 5 patients who passed away due to septic shock.

Conclusions Our study confirms that ERCP, while generally safe and effective, carries a non-negligible risk of complications, with a higher incidence observed in cases of choledocholithiasis and malignant biliary strictures. These complications are well-recognized and are largely dependent on both the complexity of the procedure and patient-specific factors. Cholangitis, hemorrhage, and post-ERCP pancreatitis were the most frequent complications in our series, which practitioners should be able to recognize and manage effectively to improve patient prognosis.

Publication History

Article published online:
27 March 2025