ERCP Bootcamp (On-Demand) | July 2026-Krafft_Management of Post Sphincterotomy Bleeding Perforation and Wire Guided Injury

Krafft_Management of Post Sphincterotomy Bleeding Perforation and Wire Guided Injury

Pdf Summary

This document is a lecture on ERCP adverse events, focusing on post-sphincterotomy bleeding, perforation, and wire-guided injury. It emphasizes that ERCP is one of the riskiest routine procedures in gastroenterology and that serious complications are more likely when the indication for ERCP is uncertain.<br /><br />The presentation reviews major adverse events and their approximate incidence and mortality, highlighting that perforation, though rare, carries the highest mortality. It explains the anatomy of the major duodenal papilla and how sphincterotomy technique can reduce bleeding risk by directing the cut toward the 10–11 o’clock position, where papillary arteries are less dense.<br /><br />Key bleeding risk factors include thrombocytopenia, end-stage renal disease with hemodialysis, antithrombotic therapy, intraprocedural bleeding, cirrhosis, low-volume centers, and cholangitis. The talk also reviews peri-procedural management of antiplatelet and anticoagulant medications, including when to stop, resume, or bridge therapy.<br /><br />Management of post-sphincterotomy bleeding is presented in steps: first balloon tamponade and dilute epinephrine injection, then thermotherapy, clips, fully covered self-expanding metal stents, or hemostatic powders, with angiography or CTA for refractory cases.<br /><br />The perforation section discusses risk factors such as sphincterotomy, precut sphincterotomy, biliary stricture dilation, ampullectomy, and sphincter of Oddi dysfunction. It uses the Stapfer classification to categorize perforations and outlines treatment by type: immediate endoscopic closure or stenting, decompression, drainage, antibiotics, nutrition support, and early surgical consultation when needed.<br /><br />Several cases illustrate real-world management, including post-sphincterotomy bleeding controlled with epinephrine and BiCAP, and Stapfer type II perforations treated with biliary fully covered metal stents and percutaneous drainage.

Keywords

ERCP

post-sphincterotomy bleeding

perforation

wire-guided injury

gastroenterology complications

sphincterotomy technique

antithrombotic management

Stapfer classification

endoscopic hemostasis

fully covered metal stent