GUIDELINEComplicationsofERCPThisisoneofaseriesofpositionstatementsdiscussingtheuseofGIendoscopyincommonclinicalsituations.TheStandardsofPracticeCommitteeoftheAmericanSocietyforGastrointestinalEndoscopypreparedthistext.ThisdocumentisanupdateofapreviousASGEpublica-tion.1Inpreparingthisdocument,asearchofthemedicalliteraturewasperformedusingPubMed.Additionalrefer-enceswereobtainedfromthebibliographiesoftheidenti-fiedarticlesandfromrecommendationsofexpertconsul-tants.Whenlimitedornodataexistfromwell-designedprospectivetrials,emphasisisgiventoresultsfromlargeseriesandreportsfromrecognizedexperts.Positionstate-mentsarebasedonacriticalreviewoftheavailabledataandexpertconsensusatthetimethatthedocumentwasdrafted.Furthercontrolledclinicalstudiesmaybeneededtoclarifyaspectsofthisdocument,whichmayberevisedasnecessarytoaccountforchangesintechnology,newdata,orotheraspectsofclinicalpractice.Thisdocumentisintendedtobeaneducationaldevicetoprovideinformationthatmayassistendoscopistsinprovidingcaretopatients.Thispositionstatementisnotaruleandshouldnotbeconstruedasestablishingalegalstandardofcareorasencouraging,advocating,requir-ing,ordiscouraginganyparticulartreatment.Clinicaldecisionsinanyparticularcaseinvolveacomplexanal-ysisofthepatient’sconditionandavailablecoursesofaction.Therefore,clinicalconsiderationsmayleadanendoscopisttotakeacourseofactionthatvariesfromthispositionstatement.Sinceitsintroductionin1968,ERCPhasbecomeacom-monlyperformedendoscopicprocedure.2ThediagnosticandtherapeuticutilityofERCPhasbeenwelldemonstratedforavarietyofdisorders,includingthemanagementofcho-ledocholithiasis,thediagnosisandmanagementofbiliaryandpancreaticneoplasms,andthepostoperativemanage-mentofbiliaryperioperativecomplications.3-5TheevolutionoftheroleofERCPhasoccurredsimultaneouslywiththatofotherdiagnosticandtherapeuticmodalities,mostnotablymagneticresonanceimaging/MRCP,laparoscopiccholecys-tectomy(withorwithoutintraoperativecholangiography),andEUS.ForendoscopiststoaccuratelyassesstheclinicalappropriatenessofERCP,itisimportanttohaveathoroughunderstandingofthepotentialcomplicationsofthisproce-dure.Numerousstudieshavehelpeddeterminetheexpectedratesofcomplications,potentialcontributingfactorsfortheseadverseevents,andpossiblemethodsforimprovingthesafetyofERCP.RecognitionandunderstandingofpotentialcomplicationsofERCParevitalintheacquisitionofappro-priateinformedconsent.6Reportedcomplicationratesvarywidelyinthepublishedliteraturebecauseofdifferencesinstudydesign,patientpopulation,anddefinitionsofcompli-cations.ThediagnosisandmanagementofallcomplicationsofERCParebeyondthescopeofthisdocument;however,generalprinciplesarediscussed.PANCREATITISIncidencePancreatitisisthemostcommonseriousERCPcomplication.7-15Althoughtransientincreaseinserumpancreaticenzymesmayoccurinasmanyas75%ofpatients,16suchanincreasedoesnotnecessarilyconstitutepancreatitis.Awidelyusedconsensusdefinitionforpost-ERCPpancreatitis(PEP)is(1)neworworsenedabdominalpain,(2)neworprolongationofhospitalizationforatleast2days,and(3)serumamylase3timesormoretheupperlimitofnormal,measuredmorethan24hoursaftertheprocedure.17Byusingthisorsimilardefinitions,theinci-denceofPEPinameta-analysisof21prospectivestudieswasapproximately3.5%18butrangeswidely(1.6%-15.7%)dependingonpatientselection.19,20TheratesofPEPinpediatricpatientsapproachthoseseeninadults.21RiskfactorsNum...
