Monday, May 20, 2019

Complications of ERCP

EMdOCS - mAY 20, 2019 - Authors: Montrief t and Boin n
Edited by Koyfman a and Long B
"...Take Home Points:
  • The most common post-ERCP complication is acute pancreatitis, followed by gastrointestinal bleeding, viscous perforation, and biliary tract infections.
  • Risk factors for post-ERCP complications include patient factors (aberrant anatomy, renal failure, presence of coagulopathy), provider factors (experience and appropriate endoscope disinfection), and procedure factors (multiple cannulation attempts, contrast injection, intraoperative gallbladder opacification).
  • A transient increase in serum pancreatic enzymes is common following ERCP, found in up to 75% of patients.
  • When evaluating a post-ERCP viscous perforation, the amount of intraperitoneal air does not correlate with the severity of the perforation, but rather reflects the degree of endoscopic insufflation after the perforation occurred.
  • Up to 29% of asymptomatic patients have evidence of retroperitoneal air on CT scan performed 24 hours after ERCP.
  • Most post-ERCP gastrointestinal bleeding is mild, however, severe intra-abdominal hemorrhage can occur.
  • Post-ERCP biliary infections are typically unimicrobial; the most common organisms implicated are Enterobacteriaceae (Escherichia coli and Klebsiella species), Staphylococcus epidermidis, alpha hemolytic streptococci, Enterococcus, and Pseudomonas aeruginosa."