Complications of endoscopic retrograde sphincterotomy: computed tomographic evaluation

Area of Science:

• Gastroenterology
• Radiology
• Surgical Complications

Background:

• Endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy, while generally safe, can result in post-procedural complications.
• Persistent abdominal pain, fever, and leukocytosis warrant investigation for ERCP-related issues.

Purpose of the Study:

• To evaluate the utility of computed tomography (CT) in diagnosing complications following ERCP with sphincterotomy.
• To assess the range of complications detected by CT and their management.

Main Methods:

• Retrospective review of 36 patients undergoing CT for suspected ERCP complications.
• Analysis of CT findings, including pancreatitis, duodenal perforation, air dissection, pneumoperitoneum, and abscess.
• Correlation of CT findings with clinical management and outcomes.

Main Results:

• CT identified various complications, including acute pancreatitis (23 patients) and duodenal perforation (11 patients).
• Eight patients showed normal CT scans with expected air and contrast in the biliary tree.
• CT effectively assessed injury severity and monitored therapeutic response.
• 31 of 36 patients were managed conservatively; 4 required surgery, and 1 needed intensive care.

Conclusions:

• Computed tomography (CT) is the preferred imaging modality for evaluating suspected complications after ERCP with sphincterotomy.
• CT aids in accurate diagnosis, severity assessment, and guiding management, with most patients responding to conservative treatment.