ERCP Bootcamp: Cutting Edge Comprehensive Training for the Team | July 2026-ERCP Adverse Events: Management of post sphincterotomy bleeding, perforation, and wire guided injury

ERCP Adverse Events: Management of post sphincterotomy bleeding, perforation, and wire guided injury

Video Transcription

Video Summary

This talk reviewed major ERCP adverse events beyond pancreatitis, focusing on bleeding and perforation. The speaker explained different biliary interventions, including papillotomy, sphincterotomy, and balloon sphincteroplasty, and how technique affects bleeding risk. Key bleeding risk factors included platelet count under 50,000, hemodialysis/uremia, use of antiplatelets or anticoagulants, active cholangitis, and chronic biliary obstruction with possible vitamin K deficiency. Prevention and treatment strategies included holding blood thinners when appropriate, using balloon tamponade, dilute epinephrine injection, fully covered metal stents, and, rarely, IR embolization.  <br /><br />Perforation was described as less common but potentially more lethal if missed. Risk factors included ampullectomy, sphincterotomy, pre-cut techniques, difficult strictures, and guidewire-related duct injury. The speaker emphasized recognizing perforations early using fluoroscopy and extra vigilance from staff, noting that keeping a wire in place until the end can help with rescue stenting.

Asset Subtitle

Matthew R. Krafft, MD

Keywords

ERCP adverse events

bleeding risk factors

perforation

sphincterotomy

balloon tamponade

covered metal stents