Rare and underappreciated complications of endoscopic retrograde cholangiopancreatography

Adverse Events in Endoscopic Retrograde Cholangiopancreticography for Choledocholithiasis: A Holistic Perspective

Background and aims In this study, we aimed to investigate the frequency of adverse events (AEs) in patients undergoing endoscopic retrograde cholangiopancreticography (ERCP) for choledocholithiasis and the independent risk factors that may cause these conditions. We planned to evaluate all AEs including cardiopulmonary complications and the risk factors that may affect them holistically. Methods This study was designed as a retrospective cohort study conducted at a single tertiary center's gastroenterology clinic. The study included patients with naive papillae and undergoing ERCP for choledocholithiasis between May 2019 and June 2022. Risk factors that may lead to AEs were analyzed in terms of both patient-related factors and procedure-related factors. Patients with and without AEs after ERCP were compared. Results This study included 812 patients who underwent ERCP for choledocholithiasis. AE occurred in 149 (18.3%) of patients, and the most common complication was pancreatitis (n=112, 13.8%). In regression analysis, of the patient- and procedure-related factors, only difficult cannulation was a significant independent risk factor for AEs (odds ratio=3.85, 95% CI: 1.102-13.498, p=0.035). Conclusion This study showed that, of patient- and procedure-related factors, only difficult cannulation is an independent risk factor for ERCP-related AEs.

When in Trouble Think of the Bubble: Paradoxical Cerebral Arterial Gas Embolism after Endoscopic Retrograde Cholangiopancreatography

Air embolism (a result of direct communication with the vasculature and an external pressure gradient from the gastrointestinal or the biliary tract), although rare, is a potentially devastating adverse event seen in endoscopic retrograde cholangiopancreatography (ERCP) procedures. Whether venous, arterial, or paradoxical, the clinical presentation ranges from asymptomatic patients to cardiorespiratory arrest. This is of particular importance because it makes the diagnosis of air embolism even more difficult in an already sedated patient. Since early recognition increases the chances of patients' survival, endoscopists should be highly motivated and trained to recognize this complication as early as possible. With only 60 cases of air embolism reported (and even fewer related to paradoxical air embolism), we aimed to report a case of paradoxical cerebral air embolism in a patient undergoing ERCP due to a common bile duct stricture and to provide a mini-review of this clinical entity that can serve as a bedside quick reference guide for endoscopists worldwide.

Endoscopic Retrograde Cholangiopancreatography-Related Complications and Their Management Strategies: A "Scoping" Literature Review

Endoscopic retrograde cholangiopancreatography (ERCP) is a well-known procedure with both diagnostic and therapeutic utilities in managing pancreaticobiliary conditions. With the advancements of endoscopic techniques, ERCP has become a relatively safe and effective procedure. However, as ERCP is increasingly being utilized for different advanced techniques, newer complications have been noticed. Post-ERCP complications are known, and mostly include pancreatitis, infection, hemorrhage, and perforation. The risks of these complications vary depending on several factors, such as patient selection, endoscopist's skills, and the difficulties involved during the procedure. This review discusses post-ERCP complications and management strategies with new and evolving concepts.

FREQUENCY OF EARLY POST-ERCP ADVERSE EVENTS IN BOTH DIAGNOSTIC AND THERAPEUTIC PROCEDURES

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is widely used for diagnosis and treatment of hepatobiliary disorders. However, there are many adverse events associated with this procedure. The objective of this study was to determine the frequency of early post-ERCP adverse events in both diagnostic and therapeutic procedures in our set-up. Material & Methods: This cross-sectional study was conducted at Department of Gastroenterology, Hayatabad Medical Complex, Peshawar, Pakistan, from 20th December, 2016 to 20th January, 2017. Consecutive sampling technique was used. Patients undergoing ERCP whether diagnostic or therapeutic, irrespective of age and gender, were included. Those having evidence of pancreatitis, cholangitis, or previous ERCP, or abdominal surgery were excluded. The outcome was early post-ERCP complications including pancreatitis, cholangitis, bleeding and perforation. The patients were assessed for these complications immediately and 72 hours after the procedure. Demographic data like age and gender were recorded. The data regarding early post-ERCP complications were recorded and presented as frequencies. Results: Total 102 patients were included in the study. Among these, 38(37.3%) were males and 64 (62.7%) females. Mean age of patients included was 50.89±15.67 years (range 8 to 90 years). Overall post-ERCP complications were noted in 6(5.88%) patients. The most common complication was cholangitis in 5(4.9%) patients, followed by pancreatitis in only one (0.98%). Bleeding and perforation occurred in none of our patients. Conclusion: The most common Post-ERCP complication is cholangitis. Based on our findings, we suggest closer monitoring of patients undergoing ERCP for development of infection. Proper disinfection protocols should be followed to prevent infection.