ASGE Recognized Industry Associate (ARIA) Training Program for Medtronic

Managing ERCP Adverse Events

Pdf Summary

The document "Dodging Disasters: Managing ERCP Adverse Events" by Mustafa Arain, MD, focuses on understanding and managing the adverse events associated with Endoscopic Retrograde Cholangiopancreatography (ERCP). It underscores that the risks related to ERCP are not solely technical but also involve considerations of indication, consent, technological, and anatomical limitations. Alternatives to ERCP, such as Endoscopic Ultrasound (EUS) and MRI/MRCP, are mentioned, emphasizing the importance of assessing whether ERCP is necessary.<br /><br />The document categorizes adverse events into three primary types: perforation, bleeding, and pancreatitis. Post-ERCP Pancreatitis (PEP) is notably the most common adverse event, occurring at a rate of 3-8% and resulting in significant healthcare costs. The criteria for diagnosing PEP include new or worsening abdominal pain and elevated serum enzymes post-ERCP. The document also notes discrepancies in studies of PEP prophylactic therapies due to limitations in consensus criteria.<br /><br />Preventative measures and risk factors are discussed, including patient-related factors (like age and history of PEP), procedure-related factors, and the role of pharmacological interventions. The document mentions the use of NSAIDs and pancreatic stents in mitigation strategies. The management of adverse events relies on early recognition, maintaining duct access, appropriate medical interventions, and multidisciplinary communication.<br /><br />The discussion extends to other complications such as post-sphincterotomy bleeding and perforations, stressing the need to evaluate and mitigate specific risks such as the use of anticoagulants and prior surgical anatomy. The treatise underlines the importance of informed ERCP application, strategic risk management, appropriate clinical interventions, and open communication to handle adverse events effectively.

Keywords

ERCP

adverse events

post-ERCP pancreatitis

perforation

bleeding

risk management

NSAIDs

pancreatic stents

multidisciplinary communication

informed consent