Sepsis complications in endoscopic retrograde cholangiopancreatography

The overall complications rate with endoscopic retrograde cholangiopancreatography (ERCP) has been justifiably small. However, serious septic sequelae have resulted in extended morbidity and occasional mortality. This occurs following successful cannulation and the injection of contrast media in two clinical conditions: (1) when ductal obstruction impairs proper drainage and (2) when a pseudocyst is injected. The initial experience at Walter Reed and Madigan Army Medical Centers with 71 attempted ERCP procedures includes two cases of pseudocyst abcess. Although this represents only a 2.8 per cent overall incidence of infection, it constitutes a 33.3 per cent rate in the six patients with pseudocysts evaluated. Therefore, it is recommended that routine ERCP be contraindicated in suspected pseudocysts.