Improving Quality and Safety in the Endoscopy Unit (On-Demand)

ASGE Adverse Events ERCP

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The American Society for Gastrointestinal Endoscopy's guideline on adverse events related to ERCP (endoscopic retrograde cholangiopancreatography) outlines potential complications, risk factors, and preventive strategies. Since its adoption in 1968, ERCP’s role has shifted from diagnostic to primarily therapeutic due to advancements in imaging techniques like MRI and EUS. This document emphasizes the importance of understanding ERCP’s potential adverse events and implementing risk-reduction strategies.<br /><br />Post-ERCP pancreatitis (PEP) is highlighted as a significant complication, defined by consensus as new or worsened abdominal pain and elevated pancreatic enzymes. The incidence ranges from 3-10%, with higher rates in high-risk patients. Identified risk factors include younger age, female sex, a history of PEP, and biliary sphincter of Oddi dysfunction (SOD). Procedure-related factors, such as difficult cannulation and pancreatic duct manipulation, also increase the risk.<br /><br />Preventive measures for PEP involve appropriate patient selection, using alternate diagnostic methods like EUS and MRCP when suitable. Technical modifications, like wire-guided cannulation and the use of pancreatic duct stents, prove effective in reducing PEP risk. Pharmacological strategies include rectal NSAIDs like indomethacin, which have been shown to significantly lower PEP incidence and severity.<br /><br />Post-ERCP bleeding is a concern, mostly arising from sphincterotomy. Risk management includes limiting sphincterotomy in high-risk patients and using procedural techniques like balloon dilation cautiously. Duodenoscope-related infections and perforations are additional serious adverse events, managed by strict adherence to reprocessing protocols and selective use of antibiotics and endoscopic techniques respectively.<br /><br />Highlighting the importance of expert handling, the guideline suggests continuous updating of strategies in response to evolving technology and data. Recommendations are graded using the GRADE system to provide a robust, evidence-based approach in managing ERCP’s adverse events.

Keywords

ERCP

post-ERCP pancreatitis

adverse events

risk factors

preventive strategies

biliary sphincter of Oddi dysfunction

rectal NSAIDs

sphincterotomy

duodenoscope-related infections

GRADE system