Giri S, Afzalpurkar S, Gore P, Khatana G, Sahu SK, Praharaj DL, Mallick B, Nath P, Sundaram S, Sahu MK. Post-endoscopic retrograde cholangiopancreatography cholecystitis: A review of incidence, risk factors, prevention, and management. World J Gastrointest Endosc 2025; 17(7): 108030 [DOI: 10.4253/wjge.v17.i7.108030]
Corresponding Author of This Article
Shivaraj Afzalpurkar, MD, Consultant, Department of Gastroenterology, Nanjappa Multispecialty Hospital, Basappa Road, Tharalabalu Badavane, Davangere 577005, Karnataka, India. drshivaraj62@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Suprabhat Giri, Saroj Kanta Sahu, Dibya Lochan Praharaj, Bipadabhanjan Mallick, Preetam Nath, Manoj Kumar Sahu, Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, Bhubaneswar 751024, Odisha, India
Shivaraj Afzalpurkar, Department of Gastroenterology, Nanjappa Multispecialty Hospital, Davangere 577005, Karnataka, India
Prasanna Gore, Department of Gastroenterology, Renova Neelima Hospital, Hyderabad 500018, Telangana, India
Gaurav Khatana, Department of Gastroenterology, Medanta-The Medicity, Gurgaon 122001, Haryana, India
Sridhar Sundaram, Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Mumbai 400012, Maharashtra, India
Co-first authors: Suprabhat Giri and Shivaraj Afzalpurkar.
Author contributions: Giri S and Afzalpurkar S contribute equally to this study as co-first authors; Giri S and Afzalpurkar S contributed to the conception and design of the manuscript and the critical revision of the initial manuscript; all authors contributed to the literature review, analysis, data collection, and interpretation; Giri S, Afzalpurkar S, and Gore P drafted the initial manuscript; all the authors approved the final version of the manuscript.
Conflict-of-interest statement: Dr. Afzalpurkar has nothing to disclose.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shivaraj Afzalpurkar, MD, Consultant, Department of Gastroenterology, Nanjappa Multispecialty Hospital, Basappa Road, Tharalabalu Badavane, Davangere 577005, Karnataka, India. drshivaraj62@gmail.com
Received: April 3, 2025 Revised: April 27, 2025 Accepted: June 7, 2025 Published online: July 16, 2025 Processing time: 97 Days and 13.6 Hours
Abstract
Post-endoscopic retrograde cholangiopancreatography (ERCP) cholecystitis (PEC) is a recognized adverse event associated with ERCP. The incidence of PEC is low in patients undergoing ERCP, but is high in specific subgroups, such as those receiving fully-covered self-expandable metallic stents (SEMS). Several risk factors contribute to PEC, including gallbladder (GB)-related factors like tumor involvement of the orifice of the cystic duct (OCD) or feeding artery, and associated gallstones. Stent-related factors, such as covered stent placement and high axial force stents, and procedure-related factors, including stent placement across the OCD and contrast injection into the GB, further elevate the risk. Prevention strategies focus on modifying techniques, such as careful contrast administration and stent selection (uncovered or low axial force SEMS), and considering prophylactic GB drainage through endoscopic transpapillary GB drainage (ETGBD) or endoscopic ultrasound-guided GB drainage (EUS-GBD), especially in high-risk patients. Treatment options for PEC range from conservative management with antibiotics to more invasive interventions like percutaneous transhepatic GB aspiration or drainage, endoscopic techniques (ETGBD, EUS-GBD), and cholecystectomy. The choice of treatment depends on the severity of cholecystitis, the patient's condition, and other factors. The present review summarizes the currently available literature on the incidence, predictors, prevention, and management of PEC.
Core Tip: The incidence of cholecystitis after endoscopic retrograde cholangiopancreatography is usually low but can increase up to 33% in high-risk individuals. Prevention in these cases involves careful contrast administration and stent selection, and considering prophylactic endoscopic gallbladder drainage. A step-up approach may be acceptable in mild cases, which include conservative treatment or percutaneous aspiration followed by drainage if needed. Endoscopic drainage after stent removal is often the first line for moderate to severe cases after covered metal stent placement. Endoscopic ultrasound-guided or percutaneous drainage is preferred in cystic duct obstruction. Treatment strategies should be tailored to the patient's condition, cholecystitis severity, and prognosis.
