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Post-endoscopic retrograde cholangiopancreatography (ERCP) bleeding

Silvano Loperfido, MD
Guido Costamagna, MD, FACG
Francesco Ferrara, MD
Section Editor
Douglas A Howell, MD, FASGE, FACG
Deputy Editor
Anne C Travis, MD, MSc, FACG, AGAF


Bleeding was the most feared complication when therapeutic biliary endoscopy was first introduced [1]. Because of advances in equipment and experience, it has become a relatively uncommon complication of endoscopic retrograde cholangiopancreatography (ERCP), and it is mostly observed after sphincterotomy. Clinically important bleeding is uncommon with diagnostic ERCP, apart from sporadic Mallory-Weiss tears and from minor submucosal hemorrhages observed following manipulation of the papilla, particularly in patients with ampullary tumors, a bleeding diathesis, or anatomical variants such as Billroth II gastrectomy [2,3]. Exceptions are case reports in which serious bleeding occurs from injury to the spleen, liver, or abdominal vessels. (See "Rare complications of endoscopic retrograde cholangiopancreatography (ERCP)".)

This topic review will focus on the risk factors and treatment of bleeding occurring following endoscopic sphincterotomy. An overview of the complications of ERCP and detailed discussions of individual complications are presented separately. (See "Endoscopic retrograde cholangiopancreatography: Indications, patient preparation, and complications".)


Post-ERCP bleeding can be defined as clinically significant or not clinically significant [4] and can be graded as mild, moderate, or severe based upon a consensus definition [5]:

Mild – clinical evidence of bleeding (ie, not just endoscopic), hemoglobin drop <3 g/dL, and no need for transfusion

Moderate – need for transfusion (4 units or less), and no angiographic intervention or surgery


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Literature review current through: Sep 2016. | This topic last updated: Sep 23, 2016.
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