Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Rare complications of endoscopic retrograde cholangiopancreatography (ERCP)

Andrea Tringali, MD, PhD
Silvano Loperfido, MD
Guido Costamagna, MD, FACG
Section Editor
Douglas A Howell, MD, FASGE, FACG
Deputy Editor
Kristen M Robson, MD, MBA, FACG


The most frequent complications of endoscopic retrograde cholangiopancreatography (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. These unusual adverse events, which may be difficult to manage, can be associated with significant morbidity and mortality [1,2].

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 [3]. 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 [4,5]. Miscellaneous complications were observed in 0.4 to 0.5 percent of patients, more than one-half of which were cardiopulmonary.

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: May 22, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Kwon CI, Song SH, Hahm KB, Ko KH. Unusual complications related to endoscopic retrograde cholangiopancreatography and its endoscopic treatment. Clin Endosc 2013; 46:251.
  2. Chavalitdhamrong D, Donepudi S, Pu L, Draganov PV. Uncommon and rarely reported adverse events of endoscopic retrograde cholangiopancreatography. Dig Endosc 2014; 26:15.
  3. Freeman ML, Nelson DB, Sherman S, et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med 1996; 335:909.
  4. Loperfido S, Angelini G, Benedetti G, et al. Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study. Gastrointest Endosc 1998; 48:1.
  5. Masci E, Toti G, Mariani A, et al. Complications of diagnostic and therapeutic ERCP: a prospective multicenter study. Am J Gastroenterol 2001; 96:417.
  6. Andriulli A, Loperfido S, Napolitano G, et al. Incidence rates of post-ERCP complications: a systematic survey of prospective studies. Am J Gastroenterol 2007; 102:1781.
  7. Trap R, Adamsen S, Hart-Hansen O, Henriksen M. Severe and fatal complications after diagnostic and therapeutic ERCP: a prospective series of claims to insurance covering public hospitals. Endoscopy 1999; 31:125.
  8. Arrowsmith JB, Gerstman BB, Fleischer DE, Benjamin SB. Results from the American Society for Gastrointestinal Endoscopy/U.S. Food and Drug Administration collaborative study on complication rates and drug use during gastrointestinal endoscopy. Gastrointest Endosc 1991; 37:421.
  9. Michalodimitrakis M, Christodoulou P, Tsatsakis AM, et al. Death related to midazolam overdose during endoscopic retrograde cholangiopancreatography. Am J Forensic Med Pathol 1999; 20:93.
  10. Fisher L, Fisher A, Thomson A. Cardiopulmonary complications of ERCP in older patients. Gastrointest Endosc 2006; 63:948.
  11. Sharma VK, Nguyen CC, Crowell MD, et al. A national study of cardiopulmonary unplanned events after GI endoscopy. Gastrointest Endosc 2007; 66:27.
  12. Draganov PV, Forsmark CE. Prospective evaluation of adverse reactions to iodine-containing contrast media after ERCP. Gastrointest Endosc 2008; 68:1098.
  13. Draganov P, Cotton PB. Iodinated contrast sensitivity in ERCP. Am J Gastroenterol 2000; 95:1398.
  14. Burdick JS, Schmalz MJ, Geenen JE. Guidewire fracture during endoscopic sphincterotomy. Endoscopy 1993; 25:251.
  15. Johlin FC, Tucker RD, Ferguson S. The effect of guidewires during electrosurgical sphincterotomy. Gastrointest Endosc 1992; 38:536.
  16. Ell C, Fleig WE, Hochberger J. Broken biliary metal stent after repeated electrocoagulation for tumor ingrowth. Gastrointest Endosc 1992; 38:197.
  17. Petersen BT, Hussain N, Marine JE, et al. Endoscopy in patients with implanted electronic devices. Gastrointest Endosc 2007; 65:561.
  18. Katsinelos P, Pilpilidis I, Paroutoglou G, et al. Pyogenic cholangitis after inadvertent submucosal contrast injection in the papilla of Vater in a patient with cholestatic hepatitis. Surg Endosc 2003; 17:1677.
  19. Huibregtse K, Gish R, Tytgat GN. A frightening event during endoscopic papillotomy. Gastrointest Endosc 1988; 34:67.
  20. Ben-Zvi JS, Siegel JH, Yatto R. Opacification of the portal system during ERCP: demonstration of an anomalous pancreatico-portal connection in a patient with pancreatic carcinoma. Gastrointest Endosc 1989; 35:445.
  21. Siegel JH, Ben-Zvi JS, Yatto RP. Portal vein filling during ERCP. Gastrointest Endosc 1993; 39:471.
  22. Ricci E, Mortilla MG, Conigliaro R, et al. Portal vein filling: a rare complication associated with ERCP for endoscopic biliary stent placement. Gastrointest Endosc 1992; 38:524.
  23. Espinel J, Pinedo ME, Calleja JL. Portal vein filling: an unusual complication of needle-knife sphincterotomy. Endoscopy 2007; 39 Suppl 1:E245.
  24. Cotton PB. Portal vein filling during ERCP. Gastrointest Endosc 1994; 40:120.
  25. Lum C, Cho KC, Scholl DG, Sundaram NK. Portal vein opacification during ERCP in patients with pancreatitis. Abdom Imaging 1998; 23:81.
  26. Kalaitzakis E, Stern N, Sturgess R. Portal vein cannulation: an uncommon complication of endoscopic retrograde cholangiopancreatography. World J Gastroenterol 2011; 17:5131.
  27. Kawakami H, Kuwatani M, Kudo T, et al. Portobiliary fistula: unusual complication of wire-guided cannulation during endoscopic retrograde cholangiopancreatography. Endoscopy 2011; 43 Suppl 2 UCTN:E98.
  28. Kawaguchi Y, Lin JC, Kawashima Y, et al. Accessory Pancreatic Duct-Portal Vein Fistula: A Rare Complication of Chronic Pancreatitis during Endoscopic Retrograde Cholangiopancreatography. Case Rep Gastroenterol 2014; 8:291.
  29. Gottschalk U, Morgenstern C, Kadow K. [Accidental cannulation of the hepatic artery following needle-knife sphincterotomy]. Z Gastroenterol 2007; 45:702.
  30. Maggino L, Crinò SF, Bernardoni L, et al. An unforeseeable adverse event during ERCP. Endoscopy 2016; 48 Suppl 1:E278.
  31. Dickey W, Huibregtse K, Rauws EA, Tytgat GN. Direct pancreatic lymphangiography during ERCP. Gastrointest Endosc 1995; 41:528.
  32. Furuzono M, Hirata N, Saitou J, Nakaji S. A rare complication during ERCP and sphincterotomy: placement of an endoscopic nasobiliary drainage tube in the portal vein. Gastrointest Endosc 2009; 70:588.
  33. Stableforth WD, Pathmakanthan S, Holt A, et al. Iatrogenic portobiliary fistula complicating endoscopic stenting of a pancreatic cyst, with possible carcinoma: a case report. Gastrointest Endosc 2011; 73:630.
  34. Sezgin O, Tezel A, Sahin B. Limited duodenal pneumatosis during needle-knife sphincterotomy. Endoscopy 1999; 31:S54.
  35. Donepudi S, Chavalitdhamrong D, Pu L, Draganov PV. Air embolism complicating gastrointestinal endoscopy: A systematic review. World J Gastrointest Endosc 2013; 5:359.
  36. Simmons TC. Hepatic portal venous gas due to endoscopic sphincterotomy. Am J Gastroenterol 1988; 83:326.
  37. Herman JB, Levine MS, Long WB. Portal venous gas as a complication of ERCP and endoscopic sphincterotomy. Am J Gastroenterol 1995; 90:828.
  38. Blind PJ, Oberg L, Hedberg B. Hepatic portal vein gas following endoscopic retrograde cholangiography with sphincterotomy. Case report. Eur J Surg 1991; 157:299.
  39. Barthet M, Membrini P, Bernard JP, Sahel J. Hepatic portal venous gas after endoscopic biliary sphincterotomy. Gastrointest Endosc 1994; 40:261.
  40. Merine D, Fishman EK. Uncomplicated portal venous gas associated with duodenal perforation following ERCP: CT features. J Comput Assist Tomogr 1989; 13:138.
  41. Tighe M, Jacobson I. Bleeding from bile duct varices: an unexpected hazard during therapeutic ERCP. Gastrointest Endosc 1996; 43:250.
  42. Kennedy C, Larvin M, Linsell J. Fatal hepatic air embolism following ERCP. Gastrointest Endosc 1997; 45:187.
  43. Siddiqui J, Jaffe PE, Aziz K, et al. Fatal air and bile embolism after percutaneous liver biopsy and ERCP. Gastrointest Endosc 2005; 61:153.
  44. Rabe C, Balta Z, Wüllner U, et al. Biliary metal stents and air embolism: a note of caution. Endoscopy 2006; 38:648.
  45. Cha ST, Kwon CI, Seon HG, et al. Fatal biliary-systemic air embolism during endoscopic retrograde cholangiopancreatography: a case with multifocal liver abscesses and choledochoduodenostomy. Yonsei Med J 2010; 51:287.
  46. Finsterer J, Stöllberger C, Bastovansky A. Cardiac and cerebral air embolism from endoscopic retrograde cholangio-pancreatography. Eur J Gastroenterol Hepatol 2010; 22:1157.
  47. Mohammedi I, Ber C, Peguet O, et al. Cardiac air embolism after endoscopic retrograde cholangiopancreatography in a patient with blunt hepatic trauma. J Trauma 2002; 53:1170.
  48. Giuly E, Pesenti C, Pernoud N, et al. [Air embolism: an unusual complication of endoscopic retrograde cholangiopancreatography]. Ann Fr Anesth Reanim 2005; 24:1400.
  49. Romberg C. Systemic air embolism after ERCP: a case report and review of the literature (with video). Gastrointest Endosc 2009; 70:1043.
  50. Goins KM, May JM, Hucklenbruch C, et al. Unexpected cardiovascular collapse from massive air embolism during endoscopic retrograde cholangiopancreatography. Acta Anaesthesiol Scand 2010; 54:385.
  51. Nayagam J, Ho KM, Liang J. Fatal systemic air embolism during endoscopic retrograde cholangio-pancreatography. Anaesth Intensive Care 2004; 32:260.
  52. Stabile L, Cigada M, Stillittano D, et al. Fatal cerebral air embolism after endoscopic retrograde cholangiopancreatography. Acta Anaesthesiol Scand 2006; 50:648.
  53. Tan BK, Saunier CF, Cotton F, et al. [Thoracoabdominal CT scan: a useful tool for the diagnosis of air embolism during an endoscopic retrograde cholangiopancreatography]. Ann Fr Anesth Reanim 2008; 27:240.
  54. Rangappa P, Uhde B, Byard RW, et al. Fatal cerebral arterial gas embolism after endoscopic retrograde cholangiopancreatography. Indian J Crit Care Med 2009; 13:108.
  55. Argüelles García B, García Blanco A, Meilán Martínez A, Calvo Blanco J. [Cerebral artery air embolism secondary to endoscopic retrograde cholangiopancreatography]. Gastroenterol Hepatol 2009; 32:614.
  56. van Boxel GI, Hommers CE, Dash I, et al. Myocardial and cerebral infarction due to massive air embolism following endoscopic retrograde cholangiopancreatography (ERCP). Endoscopy 2010; 42 Suppl 2:E80.
  57. Albert JG, Friedrich-Rust M, Elhendawy M, et al. Peroral cholangioscopy for diagnosis and therapy of biliary tract disease using an ultra-slim gastroscope. Endoscopy 2011; 43:1004.
  58. Bisceglia M, Simeone A, Forlano R, et al. Fatal systemic venous air embolism during endoscopic retrograde cholangiopancreatography. Adv Anat Pathol 2009; 16:255.
  59. Mal F, Choury AD, De Castro V, et al. [Fatal venous air embolism during biliary endoscopy]. Gastroenterol Clin Biol 2010; 34:e17.
  60. Di Pisa M, Chiaramonte G, Arcadipane A, et al. Air embolism during endoscopic retrograde cholangiopancreatography in a pediatric patient. Minerva Anestesiol 2011; 77:90.
  61. Jow AZ, Wan D. Complication of cardiac air embolism during ERCP and EUS-assisted cyst-gastrostomy for pancreatic pseudocyst. Gastrointest Endosc 2012; 75:220.
  62. Bechi A, Nucera MP, Olivotto I, et al. Complete neurological recovery after systemic air embolism during endoscopic retrograde cholangiopancreatography. Minerva Anestesiol 2012; 78:622.
  63. Maccarone G, Shakoor T, Ellis B. Air embolism after percutaneous transhepatic biliary drainage and subsequent endoscopic retrograde cholangiopancreatography (ERCP). Endoscopy 2011; 43 Suppl 2 UCTN:E399.
  64. Nern C, Bellut D, Husain N, et al. Fatal cerebral venous air embolism during endoscopic retrograde cholangiopancreatography-case report and review of the literature. Clin Neuroradiol 2012; 22:371.
  65. Chavalitdhamrong D, Draganov PV. Acute stroke due to air embolism complicating ERCP. Endoscopy 2013; 45 Suppl 2 UCTN:E177.
  66. Vachalová I, Ernst S, Vynogradova I, et al. Cerebral air embolism via port catheter and endoscopic retrograde cholangio-pancreatography. Springerplus 2013; 2:477.
  67. Athauda D, Tan GS, De Pablo-Fernandez E. Cerebral air embolism during endoscopic retrograde cholangiopancreatography: treatment with therapeutic hypothermia. Endoscopy 2014; 46 Suppl 1 UCTN:E151.
  68. Duburque C, Beaujard E, Landel JB, et al. Life-threatening air embolism during ERCP. Endoscopy 2014; 46 Suppl 1 UCTN:E250.
  69. Marini M, Macchiarelli R, Rentini S, et al. Cerebral air embolism as a complication of biliary endoscopy: A case report. Digestive and Liver Disease 2014; 46:S108.
  70. Arora A, Mukund A, Garg H, Patıdar Y. Portal venous air embolization. Turk J Gastroenterol 2013; 24:374.
  71. Bastovansky A, Stöllberger C, Finsterer J. Fatal Cerebral Air Embolism Due to a Patent Foramen Ovale during Endoscopic Retrograde Cholangiopancreatography. Clin Endosc 2014; 47:275.
  72. Hauser G, Milosevic M, Zelić M, Stimac D. Sudden death after endoscopic retrograde cholangiopancreatography (ERCP)--case report and literature review. Medicine (Baltimore) 2014; 93:e235.
  73. Wills-Sanin B, Cárdenas YR, Polanco L, et al. Air embolism after endoscopic retrograde cholangiopancreatography in a patient with budd Chiari syndrome. Case Rep Crit Care 2014; 2014:205081.
  74. Markin NW, Montzingo CR. Paradoxical air embolus during endoscopic retrograde cholangiopancreatography: an uncommon fatal complication. A A Case Rep 2015; 4:87.
  75. Marchesi M, Battistini A, Pellegrinelli M, et al. Fatal air embolism during endoscopic retrograde cholangiopancreatography (ERCP): An 'impossible' diagnosis for the forensic pathologist. Med Sci Law 2016; 56:70.
  76. Mathew J Jr, Parker C 3rd, Wang J. Pulseless electrical activity arrest due to air embolism during endoscopic retrograde cholangiopancreatography: a case report and review of the literature. BMJ Open Gastroenterol 2015; 2:e000046.
  77. Park S, Ahn JY, Ahn YE, et al. Two Cases of Cerebral Air Embolism That Occurred during Esophageal Ballooning and Endoscopic Retrograde Cholangiopancreatography. Clin Endosc 2016; 49:191.
  78. Cooper JS, Thomas J, Singh S, Brakke T. Endoscopic Bubble Trouble: Hyperbaric Oxygen Therapy for Cerebral Gas Embolism During Upper Endoscopy. J Clin Gastroenterol 2016.
  79. Koehler LS, Christides PS, Adamec TA. A complication of percutaneous cholangiography resulting in hypoxia and death of an anesthetized patient. Anesthesiology 1978; 49:210.
  80. Armellin GM, Smith RC, Faithfull GR. Pulmonary bile emboli following percutaneous cholangiography and biliary drainage. Pathology 1981; 13:615.
  81. Mirski MA, Lele AV, Fitzsimmons L, Toung TJ. Diagnosis and treatment of vascular air embolism. Anesthesiology 2007; 106:164.
  82. Muth CM, Shank ES. Gas embolism. N Engl J Med 2000; 342:476.
  83. Wu WC, Katon RM. Injury to the liver and spleen after diagnostic ERCP. Gastrointest Endosc 1993; 39:824.
  84. Lo AY, Washington M, Fischer MG. Splenic trauma following endoscopic retrograde cholangiopancreatography (ERCP). Surg Endosc 1994; 8:692.
  85. Gaffney RR, Jain V, Moyer MT. Splenic Injury and ERCP: A Possible Risk for Patients with Advanced Chronic Pancreatitis. Case Rep Gastroenterol 2012; 6:162.
  86. Ahmad S, Bragg D, Zaitoun AM, Lobo DN. A dangerous loop. Clin Case Rep 2016; 4:535.
  87. Risher WH, Smith JW. Intraperitoneal hemorrhage from injury to the gastroepiploic artery: a complication of endoscopic retrograde sphincterotomy. Gastrointest Endosc 1990; 36:426.
  88. Milanchi S, Magner D, Lo SK, et al. Abdominal compartment syndrome secondary to retroperitoneal hematoma as a complication of ERCP after liver transplantation. Transplant Proc 2007; 39:169.
  89. Kingsley DD, Schermer CR, Jamal MM. Rare complications of endoscopic retrograde cholangiopancreatography: two case reports. JSLS 2001; 5:171.
  90. Poon CM, Lee FY, Ko CW, et al. A rare complication of intra-abdominal hematoma after ERCP. Gastrointest Endosc 2002; 56:307.
  91. Oliveira Ferreira A, Tato Marinho R, Velosa J. Infected hepatic hematoma 10 days after ERCP. Endoscopy 2013; 45 Suppl 2 UCTN:E402.
  92. Cárdenas A, Crespo G, Balderramo D, et al. Subcapsular liver hematoma after Endoscopic Retrograde Cholangiopancreatography in a liver transplant recipient. Ann Hepatol 2008; 7:386.
  93. McArthur KS, Mills PR. Subcapsular hepatic hematoma after ERCP. Gastrointest Endosc 2008; 67:379.
  94. Zizzo M, Lanaia A, Barbieri I, et al. Subcapsular Hepatic Hematoma After Endoscopic Retrograde Cholangiopancreatography: A Case Report and Review of Literature. Medicine (Baltimore) 2015; 94:e1041.
  95. Jeong YH, Kim TN, Kim KH. Subphrenic hematoma mimicking malpositioned gallbladder during endoscopic retrograde cholangiopancreatography. Endoscopy 2015; 47 Suppl 1 UCTN:E521.
  96. Pan YM, Wang TT, Wu J, Hu B. Endoscopic drainage for duodenal hematoma following endoscopic retrograde cholangiopancreatography: a case report. World J Gastroenterol 2013; 19:2118.
  97. Costa Macedo T, Maldonado R, Valente A, et al. Hemobilia in hereditary hemorrhagic telangiectasia: an unusual complication of endoscopic retrograde cholangiopancreatography. Endoscopy 2003; 35:531.
  98. Inoue H, Tano S, Takayama R, et al. Right hepatic artery pseudoaneurysm: rare complication of plastic biliary stent insertion. Endoscopy 2011; 43 Suppl 2 UCTN:E396.
  99. Watanabe M, Shiozawa K, Mimura T, et al. Hepatic artery pseudoaneurysm after endoscopic biliary stenting for bile duct cancer. World J Radiol 2012; 4:115.
  100. Gholson CF, Williams C, Patterson CR. Bloody drainage following endoscopic retrograde pancreatography as a presentation of a pseudoaneurysm-containing pseudocyst. Gastrointest Endosc 1989; 35:111.
  101. al-Jeroudi A, Belli AM, Shorvon PJ. False aneurysm of the pancreaticoduodenal artery complicating therapeutic endoscopic retrograde cholangiopancreatography. Br J Radiol 2001; 74:375.
  102. Austin AS, Lobo DN, Hinwood D, et al. Intra-hepatic false aneurysm: a rare complication of ERCP. Eur J Gastroenterol Hepatol 1999; 11:1171.
  103. Nezu Y, Nakaji S, Fujii H, et al. Pseudoaneurysm caused by a self-expandable metal stent: a report of three cases. Endoscopy 2014; 46:248.
  104. Pohle T, Domschke W, Lerch MM. Needle knife precut-induced bleeding from a "pancreatic cyst". Gastrointest Endosc 2000; 52:564.
  105. Jung CH, Hyun JJ, Gu DH, et al. Acute duodenal ischemia and periampullary intramural hematoma after an uneventful endoscopic retrograde cholangiopancreatography in a patient with primary myelofibrosis. Clin Endosc 2014; 47:270.
  106. Mosenkis BN, Brandt LJ. Bleeding causing biliary obstruction after endoscopic sphincterotomy. Am J Gastroenterol 1997; 92:708.
  107. Ala A, Khin CC, van Someren N. Common bile duct thrombus: a cause of persisting obstructive jaundice after endoscopic sphincterotomy. Gastrointest Endosc 1999; 50:285.
  108. Chochon M, Colardelle P, Choury D, et al. [Cholangitis induced by an obstructive blood clot after endoscopic sphincterotomy]. Gastroenterol Clin Biol 1994; 18:529.
  109. Heller AM, Hohl R, Madhavan T, Wong K. Retropharyngeal abscess after endoscopic retrograde cholangiopancreatography: an uncommon but potentially fatal complication. South Med J 1978; 71:219.
  110. Riahi S, Hansen J, Bjerre J, Kragsbjerg P. ERCP complicated by a retroperitoneal abscess caused by Haemophilus influenzae and Haemophilus parainfluenzae. Gastrointest Endosc 1998; 47:417.
  111. Furman G, Morgenstern L. Splenic injury and abscess complicating endoscopic retrograde cholangiopancreatography. Surg Endosc 1993; 7:343.
  112. Gilad J, David A, Hertzanu Y, et al. Endoscopic biliary sphincterotomy complicated by abscess formation in a simple renal cyst. Endoscopy 1999; 31:S5.
  113. Hendlisz A, Rypens F, Gay F, et al. Spinal epidural abscess after endoscopic treatment for chronic pancreatitis. Pancreas 1995; 10:204.
  114. Tooson JD, Alexander GL, Batts KP. Perforation of the sigmoid colon after therapeutic UGI endoscopy. Gastrointest Endosc 1995; 41:608.
  115. Manbeck MA, Chang AC, McCracken JD, Chen YK. Cystic duct perforation as a complication of endoscopic stone extraction. Am J Gastroenterol 1996; 91:592.
  116. Borgharia S, Jindal V, Gautam V, et al. Subcutaneous emphysema of the penis and scrotum mimicking gas gangrene: a rare complication of ERCP. Gastrointest Endosc 2011; 73:613.
  117. Singh V, Singh G, Verma GR, et al. Pseudobowel perforation following endoscopic retrograde cholangiopancreatography. Dig Dis Sci 2013; 58:1781.
  118. Lopes L, Dinis-Ribeiro M, Rolanda C. Gaining competence in needle-knife fistulotomy - can I begin on my own? Endosc Int Open 2016; 4:E383.
  119. Rai A, Iftikhar S. Tension pneumothorax complicating diagnostic upper endoscopy: a case report. Am J Gastroenterol 1999; 94:845.
  120. Minocha A, Richards RJ. Pneumothorax complicating diagnostic upper endoscopy. Am J Gastroenterol 1999; 94:2323.
  121. Morley AP, Lau JY, Young RJ. Tension pneumothorax complicating a perforation of a duodenal ulcer during ERCP with endoscopic sphincterotomy. Endoscopy 1997; 29:332.
  122. Han ML, Wu YM, Liu KL, et al. Tension pneumothorax after an ERCP in a patient with hepatic hydrothorax and sealed-off perforated duodenal ulcer. Gastrointest Endosc 2008; 68:771.
  123. Ciaccia D, Branch MS, Baillie J. Pneumomediastinum after endoscopic sphincterotomy. Am J Gastroenterol 1995; 90:475.
  124. Markogiannakis H, Toutouzas KG, Pararas NV, et al. Bilateral pneumothorax following endoscopic retrograde cholangiopancreatography: a case report. Endoscopy 2007; 39 Suppl 1:E195.
  125. Ferrara F, Luigiano C, Billi P, et al. Pneumothorax, pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum, and subcutaneous emphysema after ERCP. Gastrointest Endosc 2009; 69:1398.
  126. Bar-Meir S, Lang A, Shemesh E, et al. Pneumoperitoneum after insertion of endoscopic biliary stent for post-cholecystectomy biliary leak. Gastrointest Endosc 1993; 39:818.
  127. Assimakopoulos SF, Thomopoulos KC, Giali S, et al. A rare etiology of post-endoscopic retrograde cholangiopancreatography pneumoperitoneum. World J Gastroenterol 2008; 14:2917.
  128. Boškoski I, Tringali A, Familiari P, Costamagna G. An unusual post-ERCP pneumoperitoneum. Dig Liver Dis 2011; 43:579.
  129. Sheridan J, Williams TM, Yeung E, et al. Percutaneous transhepatic management of an impacted endoscopic basket. Gastrointest Endosc 1993; 39:444.
  130. Cutler AF, Hassig WM, Schubert TT. Basket impaction at the pancreatic head. Gastrointest Endosc 1992; 38:520.
  131. Mutignani M, Gabbrielli A, Murali N, et al. Novel methods of management of trapped dormia baskets in the pancreatic and biliary ducts. Endoscopy 1997; 29:129.
  132. Ng WT, Yiu MK, Lee K. Impaction of a stone basket in the gallbladder with laparoscopic rescue. Gastrointest Endosc 1993; 39:217.
  133. Benatta MA, Desjeux A, Barthet M, et al. Impacted and Fractured Biliary Basket: A Second Basket Rescue Technique. Case Rep Med 2016; 2016:6210646.
  134. Nicholson AA, Martin DF. Misplacement of endoscopic biliary endoprostheses. Endoscopy 1997; 29:125.
  135. Ang BK, Wee SB, Kaushik SP, Low CH. Duodenal-colic fistula resulting from migration of a biliary stent: a case report. Gastrointest Endosc 1998; 48:80.
  136. Rosés LL, Ramirez AG, Seco AL, et al. Clip closure of a duodenal perforation secondary to a biliary stent. Gastrointest Endosc 2000; 51:487.
  137. Christensen M, Matzen P, Schulze S, Rosenberg J. Complications of ERCP: a prospective study. Gastrointest Endosc 2004; 60:721.
  138. Sánchez-Tembleque MD, Naranjo Rodríguez A, Ruiz Morales R, et al. [Duodenal perforation due to an endoscopic biliary prosthesis]. Gastroenterol Hepatol 2005; 28:225.
  139. Amann ST, Somogyi L. A wire-loop technique for removal of migrated and embedded biliary stents. Gastrointest Endosc 2000; 51:485.
  140. Paikos D, Gatopoulou A, Moschos J, et al. Migrated biliary stent predisposing to fatal ERCP-related perforation of the duodenum. J Gastrointestin Liver Dis 2006; 15:387.
  141. Ödemiş B, Köksal AŞ, Torun S. An uncommon cause of abdominal pain after endoscopic retrograde cholangiopancreatography. Wien Klin Wochenschr 2013; 125:346.
  142. Distefano M, Bonanno G, Russo A. Biliocutaneous fistula following biliary stent migration. Endoscopy 2001; 33:97.
  143. Basile A, Macri' A, Lamberto S, et al. Duodenoscrotal fistula secondary to retroperitoneal migration of an endoscopically placed plastic biliary stent. Gastrointest Endosc 2003; 57:136.
  144. Størkson RH, Edwin B, Reiertsen O, et al. Gut perforation caused by biliary endoprosthesis. Endoscopy 2000; 32:87.
  145. Ruinemans GM, van Zanten RA, Rakic S, et al. [Abdominal pain following placement of an endoprosthesis in the biliary duct]. Ned Tijdschr Geneeskd 2006; 150:1466.
  146. Wilhelm A, Langer C, Zoeller G, et al. Complex colovesicular fistula: A severe complication caused by biliary stent migration. Gastrointest Endosc 2003; 57:124.
  147. Wagemakers S, Ibelings M. [Colovesicular fistula after migration of a biliary stent]. Ned Tijdschr Geneeskd 2011; 155:A3615.
  148. Paranandi B, Joshi D, Johnson GJ, Webster GJ. Pericardiobiliary Fistulation: A Rare Complication of Therapeutic ERCP in a Patient With IgG4-Related Sclerosing Cholangitis. ACG Case Rep J 2015; 2:242.
  149. Johanson JF, Schmalz MJ, Geenen JE. Incidence and risk factors for biliary and pancreatic stent migration. Gastrointest Endosc 1992; 38:341.
  150. Diller R, Senninger N, Kautz G, Tübergen D. Stent migration necessitating surgical intervention. Surg Endosc 2003; 17:1803.
  151. Lahoti S, Catalano MF, Geenen JE, Schmalz MJ. Endoscopic retrieval of proximally migrated biliary and pancreatic stents: experience of a large referral center. Gastrointest Endosc 1998; 47:486.
  152. Chaurasia OP, Rauws EA, Fockens P, Huibregtse K. Endoscopic techniques for retrieval of proximally migrated biliary stents: the Amsterdam experience. Gastrointest Endosc 1999; 50:780.
  153. Kawakami H, Uebayashi M, Konishi K, et al. A rare complication with extraction of proximally migrated biliary stent by using a basket catheter. Gastrointest Endosc 2008; 67:1170.
  154. Odemis B, Beyazit Y, Tanoglu A, Kayacetin E. Endoscopic extraction of proximally migrated biliary stent by intrastent balloon inflation. BMJ Case Rep 2014; 2014.
  155. Elewaut A, De Vos M, Huble F, De Cock J. Unusual migration of a straight Amsterdam-type endoprosthesis for bile duct stones. Am J Gastroenterol 1989; 84:674.
  156. Heyries L, Desjeux A, Sahel J. Bile duct-duodenum and pancreatic-gastric fistulas: two exceptional complications of biliary and pancreatic stenting. Gastrointest Endosc 1999; 50:571.
  157. Richenberg JI, Amin Z, Hatfield AR, Lees WR. Pleurobiliary fistula following Tannenbaum biliary stent insertion. Eur Radiol 1996; 6:697.
  158. Hady HR, Baniukiewicz A, Luba M, et al. Bronchobiliary fistula as a complication after long-term stenting of hepatic ducts, applied by ERCP after hepatobiliary surgery due to hydatid cyst. Endoscopy 2011; 43 Suppl 2 UCTN:E178.
  159. Mahadeva S, Ranjeev P, Goh KL. Hepaticogastric fistulation from a proximally migrated biliary stent. Gastrointest Endosc 2003; 58:295.
  160. Tung BY, Kowdley KV, Kimmey MB. Pancreatic fistula without pancreatitis after endoscopic biliary stent placement for bile leak after orthotopic liver transplantation. Gastrointest Endosc 1999; 49:647.
  161. Vimalraj V, Jeswanth S, Kannan DG, et al. Acute portal vein thrombosis and massive necrosis of the liver. An unusual complication after stenting for chronic pancreatitis. JOP 2006; 7:660.
  162. Leung WD, Parashette KR, Molleston JP, Sherman S. Pancreatic stent migration into the portal vein causing portal vein thrombosis: a rare complication of a prophylactic pancreatic stent. Pancreatology 2012; 12:463.
  163. Kahaleh M, Tokar J, Conaway MR, et al. Efficacy and complications of covered Wallstents in malignant distal biliary obstruction. Gastrointest Endosc 2005; 61:528.
  164. Gutierrez JP, Wilcox CM, Mönkemüller K. Endoscopic removal of a migrated duodenal stent into the ileum using double-balloon enteroscopy. Gastrointest Endosc 2015; 81:1033; discussion 1034.
  165. Born P, Rösch T, Classen M. Spontaneous rupture of a biliary metal stent. Endoscopy 1998; 30:S78.
  166. Baron TH. Hemobilia-induced occlusion of a biliary metal expandable stent. Gastrointest Endosc 2001; 54:362.
  167. Ee H, Laurence BH. Haemorrhage due to erosion of a metal biliary stent through the duodenal wall. Endoscopy 1992; 24:431.
  168. Marano BJ Jr, Bonanno CA. Metallic biliary endoprosthesis causing duodenal perforation and acute upper gastrointestinal bleeding. Gastrointest Endosc 1994; 40:257.
  169. Cvetkovski B, Kurtz RC. Hemobilia in advanced pancreatic cancer with portal vein obstruction and a metal endobiliary stent: a case report. Gastrointest Endosc 1999; 50:420.
  170. Gardiner MF, Long WB, Haskal ZJ, Lichtenstein GR. Upper gastrointestinal hemorrhage secondary to erosion of a biliary Wallstent in a woman with pancreatic cancer. Endoscopy 2000; 32:661.
  171. Dokas S, Kotsis V, Milionis G, et al. Fatal upper gastrointestinal bleeding caused by a metal biliary stent despite stent shortening with APC. Endoscopy 2008; 40 Suppl 2:E135.
  172. Hyun CB, Bemiller T. Biliary-duodenal fistula caused by metal stent. Gastrointest Endosc 2001; 54:361.
  173. Rai R, Rose J, Manas D. Potentially fatal haemobilia due to inappropriate use of an expanding biliary stent. World J Gastroenterol 2003; 9:2377.
  174. Wong SY, Ng FH. Lower intestinal hemorrhage due to a dislodged metallic stent. Endoscopy 1997; 29:407.
  175. Jones WF, Harford W, Goldschmiedt M. Removal of plastic biliary stents placed through metal stent. Gastrointest Endosc 1993; 39:601.
  176. Vila JJ, Jiménez FJ, Irisarri R, et al. Biliorenous fistula related to self-expandable biliary metallic stent placement: a rare complication of endoscopic retrograde cholangiopancreatography. Endoscopy 2007; 39 Suppl 1:E67.
  177. Isayama H, Kawabe T, Nakai Y, et al. Cholecystitis after metallic stent placement in patients with malignant distal biliary obstruction. Clin Gastroenterol Hepatol 2006; 4:1148.
  178. Layec S, D'Halluin PN, Pagenault M, Bretagne JF. Massive hemobilia during extraction of a covered self-expandable metal stent in a patient with portal hypertensive biliopathy. Gastrointest Endosc 2009; 70:555.
  179. Akaraviputh T, Iramaneerat C, Trakarnsanga A. Liver injury from endoscopic insertion of self-expandable metallic stent to relieve biliary obstruction: a fatal complication. Gastrointest Endosc 2009; 70:554; discussion 555.
  180. Sethi S, Tewani S, Mosko J, et al. A rare case of inferior vena cava syndrome secondary to compression by a biliary stent. Gastrointest Endosc 2015; 81:1034; discussion 1034.
  181. Pruitt A, Schutz SM, Baron T, et al. Fractured hydrophilic guidewire during ERCP: a case series. Gastrointest Endosc 1998; 48:77.
  182. Heinerman M, Mann R, Boeckl O. An unusual complication in attempted non-surgical treatment of pancreatic bile duct stones. Endoscopy 1993; 25:248.
  183. Rabie ME, Al Faris S, Nasser A, et al. Parenchymal Guidewire Perforation during ERCP: An Unappreciated Injury. Case Rep Surg 2015; 2015:670323.
  184. Ortega Deballon P, Fernández Lobato R, García Septiem J, et al. Liver hematoma following endoscopic retrograde cholangiopancreatography (ERCP). Surg Endosc 2000; 14:767.
  185. Williams IM, Hughes OD, Hicks E, Lewis MH. Gall stone ileus following multiple endoscopic retrograde cholangiopancreatographies. J R Coll Surg Edinb 1997; 42:423.
  186. Oskam J, Heitbrink M, Eeftinck Schattenkerk M. Intermittent gallstone ileus following endoscopic biliary sphincterotomy. A case report. Acta Chir Belg 1993; 93:43.
  187. Welch NT, Ellis DJ, Bradby GV. Necrotizing fasciitis--a complication of "successful" endoscopic sphincterotomy. Gastrointest Endosc 1990; 36:425.
  188. Meyenberger C, Michel C, Metzger U, Koelz HR. Gallstone ileus treated by extracorporeal shockwave lithotripsy. Gastrointest Endosc 1996; 43:508.
  189. Bourke MJ, Schneider DM, Haber GB. Electrohydraulic lithotripsy of a gallstone causing gallstone ileus. Gastrointest Endosc 1997; 45:521.
  190. Sivagnanam P, Cheong E, Rhodes M. Delayed gallstone ileus presentation after ERCP and sphincterotomy. Gastrointest Endosc 2009; 69:156.
  191. Aláez-Chillarón AB, Moreno-Manso I, Martín-Vieira FJ, et al. [Gallstone ileus after endoscopic retrograde cholangiopancreatography]. Cir Cir 2017; 85:154.
  192. Narasimhan V, Ooi G, Loh D. Gallstone ileus following therapeutic endoscopic retrograde cholangiopancreatography. ANZ J Surg 2016.
  193. Chan CK, Pace RF. Misdiagnosis using endoscopic retrograde cholangiopancreatography in a patient with postcholecystectomy pain. Surg Endosc 1987; 1:179.
  194. Meier R, Jubin E, Gyr K. [Missed gallstones in endoscopic retrograde cholangiopancreatography (ERCP). Case reports]. Schweiz Rundsch Med Prax 1988; 77:61.
  195. Green JA, Goldman JH, Bernstein D, Barkin JS. Corneal abrasion occurring during ERCP. Gastrointest Endosc 1994; 40:261.
  196. Gupte AR, Draganov PV. Post-endoscopic retrograde cholangiopancreatography uvular necrosis. Clin Gastroenterol Hepatol 2009; 7:A18.
  197. Nadkarni N, D'Cruz S, Kaur N, Sachdev A. Acute parotitis after ERCP. Gastrointest Endosc 2011; 74:199; discussion 199.
  198. Schlidt R, Marsh W, Schorr S. Pseudo stroke after an ERCP. Gastrointest Endosc 1994; 40:649.
  199. To EW, Pang PC, Lee DW. Temporomandibular joint dislocation during endoscopic retrograde cholangiopancreatography examination. Endoscopy 2000; 32:S36.
  200. Katsinelos P, Paroutoglou G, Pilpilidis I, et al. Hemolysis caused by G-6PD deficiency after a difficult and prolonged therapeutic endoscopic retrograde cholangiopancreatography. Surg Endosc 2003; 17:1325.
  201. Guerriero SE. Methemoglobinemia caused by topical benzocaine. Pharmacotherapy 1997; 17:1038.
  202. Tuna Y, Akbal E, Köklü S. Thrombotic thrombocytopenic purpura following post-ERCP pancreatitis. Transfus Apher Sci 2011; 45:313.
  203. Kluender CN, Klein R, Kohler B. Dramatic increase in bilirubin after ERCP - pethidine as a possible cause of drug-induced hepatitis. Z Gastroenterol 2003; 41:1157.
  204. Patel R, Shaps J. Intramural duodenal hematoma--a complication of ERCP. Gastrointest Endosc 1982; 28:218.
  205. Sisley JF, Bowden TA, Mansberger AR Jr. Pancreatic duct disruption and duodenal hematoma associated with endoscopic retrograde cholangiopancreatography. South Med J 1987; 80:1441.
  206. Sciumè C, Geraci G, Pisello F, et al. [A rare complication of ERCP: Mallory-Weiss syndrome]. Ann Ital Chir 2005; 76:199.
  207. Dupas JL, Mancheron H, Sevenet F, et al. Hepatic subcapsular biloma. An unusual complication of endoscopic retrograde cholangiopancreatography. Gastroenterology 1988; 94:1225.
  208. Alkhateeb HM, Aljanabi TJ, Al-Azzawi KH, Alkarboly TA. Huge biloma after endoscopic retrograde cholangiopancreatography and endoscopic biliary sphincterotomy. Int J Surg Case Rep 2015; 16:7.
  209. Sonoda Y, Kobayashi K, Kawamoto M, et al. Inadvertent pancreatic duct perforation during brushing. Gastrointest Endosc 2003; 58:305.
  210. Dourakis SP, Mayroyannis C, Alexopoulou A, Hadziyannis SJ. Prolonged cholestatic jaundice after endoscopic retrograde cholangiography. Hepatogastroenterology 1997; 44:677.
  211. de Vries JH, Duijm LE, Dekker W, et al. CT before and after ERCP: detection of pancreatic pseudotumor, asymptomatic retroperitoneal perforation, and duodenal diverticulum. Gastrointest Endosc 1997; 45:231.
  212. Lim JU, Joo KR, Park JJ, et al. Duodenal obstruction following papillary stenosis: a rare complication after endoscopic sphincterotomy. Endoscopy 2010; 42 Suppl 2:E342.
  213. Kantarci M, Doganay S, Yalcin A, Cankaya B. Unusual complications during endoscopic retrograde cholangiopancreatography (ERCP): electrical burn in the liver. Clin Res Hepatol Gastroenterol 2011; 35:132.
  214. Painter NP, Kumar PA, Arora H. Acute pulmonary embolism during an endoscopic retrograde cholangiopancreatography. Ann Card Anaesth 2014; 17:145.
  215. Harnoss JM, Yung R, Brodsky RA, et al. Bronchobiliary fistula and lithoptysis after endoscopic retrograde cholangiopancreatography and liver biopsy in a patient with paroxysmal nocturnal hemoglobinuria. Am J Respir Crit Care Med 2013; 187:451.
  216. Tonolini M. Reversible acute duodenitis as a complication of endoscopic biliary stenting. J Gastrointestin Liver Dis 2014; 23:8.
  217. Bartel MJ, Bhalla R, Lopez Chiriboga AS, et al. Vision loss: another ERCP-related adverse event, also known as isolated bilateral lateral geniculate body infarction. Gastrointest Endosc 2016; 83:474.