Endoscopic retrograde cholangiopancreatography-related adverse events: What is the role of surgery today?

Table 1 Overview of key aspects related to endoscopic retrograde cholangiopancreatography and its complications, including types, risk factors, clinical presentation, diagnostic approach, management strategies, and prognosis

	Key points
Introduction	ERCP is a valuable but high-risk procedure, mainly for therapeutic purposes (e.g., bile duct stone extraction, stent placement)
Complication types	Includes pancreatitis (most common), bleeding (intraprocedural or postprocedural), perforation (duodenal, biliary tract), infection (cholangitis, cholecystitis, liver abscess), cardiopulmonary complications, post-sphincterotomy bleeding, perforation by stent migration, Dormia basket impaction
Risk factors	Patient-related (e.g., young age, sphincter of Oddi dysfunction), procedure-related (e.g., difficult cannulation, multiple attempts)
Clinical presentation	Varies by complication: Abdominal pain, fever, jaundice, anemisation, hypotension, signs of peritonitis
Diagnostic approach	Imaging: Ultrasound, CT, MRCP. Lab tests: blood count, CRP and inflammatory markers, amylase/lipase, liver function tests
Management strategies	Supportive care (fluids, analgesia), antibiotics for infection, endoscopic management. For severe cases (e.g., perforation, large bile leaks) surgical intervention
Prognosis	Most complications resolve with timely diagnosis and appropriate management. Severe cases require multidisciplinary care

This table provides a concise reference for understanding the challenges associated with endoscopic retrograde cholangiopancreatography and the importance of early detection and appropriate intervention. ERCP: Endoscopic retrograde cholangiopancreatography; CT: Computed tomography; MRCP: Magnetic resonance cholangiopancreatography; CRP: C-reactive protein.

Table 2 Endoscopic retrograde cholangiopancreatography perforations

Type of perforation	Stapfer (most used)	Howart	Incidence
Type I	Duodenal wall perforation (by endoscope)	Duodenal perforation remote from papilla	18%
Type II	Periampullary perforation (precut/sphincterotomy)	Periampullary retroperitoneal perforation	58%
Type III	Biliary or pancreatic duct perforation (by intraductal instrumentation)	Guidewire related perforation	13%
Type IV	Retroperitoneal gas alone	-	11%

Classification of endoscopic retrograde cholangiopancreatography-related perforations according to the Stapfer and Howart systems, including incidence rates. This table highlights the different types of perforations based on their anatomical location and mechanism of injury, providing a comparative perspective between the two classification methods.