The most frequent complications of ERCP and endoscopic biliary sphincterotomy are pancreatitis, cholangitis, hemorrhage, and duodenal perforation. A number of less common adverse events have also been described including cardiopulmonary complications, contrast allergy, impaction of a retrieval basket and numerous other events reported in only small numbers of patients or individual case reports.
This topic review will focus on uncommon and rare complications of ERCP. Complications that occur more frequently are discussed separately.
Uncommon complications of ERCP have been described in several large studies.
- Miscellaneous complications occurred in 25 of 2347 cases (1 percent) in a prospective series of patients who underwent biliary sphincterotomy . Six of these were cardiopulmonary events, which were fatal in three patients.
- Similar findings were noted in two Italian prospective series that included a total of 4872 patients undergoing diagnostic and therapeutic ERCP [2,3]. Miscellaneous complications were observed in 0.4 to 0.5 percent of patients, more than one-half of which were cardiopulmonary.
- In a systematic review of 14 prospective studies including a total of 12,973 patients, there were a total of 173 miscellaneous complications (1.3 percent) and nine deaths (0.07 percent) .
- A Danish study of 39 consecutive claims for compensation due to adverse events included five uncommon complications (back pain after ERCP under general anesthesia, Hashimoto thyroiditis, a fatal case of cholecystitis, tooth injury, and need for repeat uneventful ERCP due to a stone being missed at the first ERCP) .
CARDIOPULMONARY AND SEDATION-RELATED COMPLICATIONS
Severe respiratory and cardiac side effects of digestive endoscopy are infrequent . However, the risk is probably increased with ERCP due to relatively deep sedation, long duration of the examination, prone position of the patient, mean advanced age, and frequent comorbid diseases [7,8]. In a database study that included 6092 ERCPs, there were 129 cardiopulmonary events (2.1 percent) .