Complications of diagnostic and therapeutic ERCP

In the era of magnetic resonance cholangiopancreaticography (MRCP) and laparoscopic biliary surgery, indications for endoscopic retrograde cholangiopancreaticography (ERCP) should be profoundly considered in the light of ERCP related complication rate.

To evaluate the frequency of complications associated with diagnostic and therapeutic ERCP, all endoscopic procedures from 1991 to 1996 were retrospectively reviewed.

A total of 813 cannulations were performed on 590 patients. Endoscopic sphincterotomy (EST) was performed on 223 patients out of 230 attempted. Common bile duct stones were removed from 134 patients, an endoscopic stent was inserted in 69 patients and a benign stricture was dilated in 11 patients. After diagnostic ERCP, the complication rate was 1.8% with no mortality, after EST the complication rate was 9.1% with a mortality rate of 0.9%. Pancreatitis was the most common complication with a rate of 1.5% after diagnostic ERCP and 3.9% after EST. In three patients the pancreatitis was severe and resulted in the deaths of two of them. Other complications were haemorrhage after EST (2.6%), duodenal wall or bile duct perforation (0.7% of the cannulations and 2.2% of EST) and cholangitis (0.6% of all cannulations). All of these patients survived.

Complication rates were comparable with large series from clinics specialised in endoscopic procedures.