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What are the risks of ERCP? PDF Print E-mail

ERCP has become popular because it can provide a diagnosis and treatment more safely and easily than other options such as surgery.  However, ERCP is not without risk, and you must understand what can happen.

 

Taking x-rays involves a small dose of radiation no greater than other standard x-ray tests.  You could have an allergic reaction to the sedatives such as nausea or skin reactions such as reddening and hives.  A tender lump may form in the vein where the iv was placed.  This will usually settle spontaneously, but you should call your doctor if redness or swelling develops or persists.

 

Specific complications of ERCP occur in 5-10% of patients.  The precise risk depends on the particular patient, disease, and type of ERCP procedure.  Make sure you understand the likely risks in your particular case.

 

Pancreatitis (swelling of the pancreas) is the most common complication of ERCP; it occurs in 3-5% of ERCP.  It can occur even in the most expert hands.  Pancreatitis usually resolves in one to three days, but you will need to be in the hospital with iv fluids and analgesics (pain medicines).  More serious cases of pancreatitis occur in less than 1% of ERCP procedures.  Severe pancreatic damage can result in formation of a pseudocyst or abscess, which may require a prolonged stay in the hospital.  Rare fatal cases of pancreatitis related to ERCP have been reported.

 

Other important complications are less common, and occur mainly after treatments such as sphincterotomy.  This may provoke bleeding, which can usually be controlled by the doctor during the ERCP.  Rarely it is necessary to give a blood transfusion or other treatment such as surgery.  Sphincterotomy can also result in perforation when the cut extends into the tissues behind the duodenum and pancreas.  Some perforations can be treated medically (with iv fluids, antibiotics, and a nasogastric tube); other cases may require surgery and prolonged hospital treatment.

 

Very rarely, the endoscope itself can perforate (make a hole) in the lining of the esophagus, stomach or duodenum.  This type of perforation usually requires surgical treatment.

 

Infection can occur in the bile ducts or pancreas after ERCP, especially when there is duct obstruction which cannot be treated by the ERCP procedure.  Antibiotics will be required, and possibly another type of drainage procedure such as surgery.