Complications are inherent in the performance of endoscopic procedures and more so for endoscopic retrograde cholangiopancreatography (ERCP). Knowledge of potential ERCP complications, their expected frequency, and the risk factors for their occurrence may help to recognize and to minimize the incidence and severity of complications. Endoscopists are expected to carefully select patients for the appropriate intervention, be familiar with the planned procedure and available technology, and be prepared to manage any adverse events that may arise. Once a complication occurs, early recognition and prompt intervention may minimize the morbidity and mortality associated with that complication. Review of complications as part of a continuing quality improvement process may serve to educate endoscopists, help to reduce the risk of future complications, and improve the overall quality of ERCP.
Endoscopic retrograde cholangiopancreatography (ERCP) related complications
Note: The diagnosis and management of all complications of ERCP are beyond the scope of this document; however, general principles are discussed.
Allied Health Personnel
- To provide information that may assist endoscopists in providing care to patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) and increase knowledge of potential complications.
- To update the 2003 American Society of Gastrointestinal Endoscopy (ASGE) guideline on complications of ERCP
Patients undergoing endoscopic retrograde cholangiopancreatography (ERCP)
- Endoscopists are expected to:
- Select patients carefully
- Be aware of potential endoscopic retrograde cholangiopancreatography (ERCP) complications, their expected frequency, and the risk factors associated with their occurrence
- Be familiar with the planned procedure and available technology
- Be prepared to manage any adverse events
- Early recognition and prompt intervention of complications
- Review of complications to reduce future risk and improve overall quality
- Cardiopulmonary complications
- Other miscellaneous endoscopic retrograde cholangiopancreatography (ERCP) complications
Hand-searches of Published Literature (Primary Sources)
Hand-searches of Published Literature (Secondary Sources)
Searches of Electronic Databases
The Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy performed a search of the medical literature using PubMed (1990-2011). Additional references were obtained from the bibliographies of the identified articles and from recommendations of expert consultants. When limited or no data exist from well-designed prospective trials, emphasis is given to results from large series and reports from recognized experts.
- The committee meets formally twice a year (Spring and Fall) and edit/complete documents by consensus. The time from completion and publication is typically less than 6 weeks and data is updated until completion of the article based on emerging evidence.
- Position statements are based on a critical review of the available data and expert consensus at the time the documents are drafted.
A formal cost analysis was not performed and published cost analyses were not reviewed.
Internal Peer Review
This document was reviewed and approved by the Governing Board of the American Society for Gastrointestinal Endoscopy.
The type of evidence supporting the recommendations is not specifically stated.
Knowledge of potential endoscopic retrograde cholangiopancreatography (ERCP) complications, their expected frequency, and the risk factors for their occurrence may help to recognize and to minimize the incidence and severity of complications.
- Position statements are based on a critical review of the available data and expert consensus at the time that the document was drafted. Further controlled clinical studies may be needed to clarify aspects of this document, which may be revised as necessary to account for changes in technology, new data, or other aspects of clinical practice.
- This document is intended to be an educational device to provide information that may assist endoscopists in providing care to patients. This position statement is not a rule and should not be construed as establishing a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment. Clinical decisions in any particular case involve a complex analysis of the patient's condition and available courses of action. Therefore, clinical considerations may lead an endoscopist to take a course of action that varies from this position statement.
An implementation strategy was not provided.
|ASGE Standards of Practice Committee, Anderson MA, Fisher L, Jain R, Evans JA, Appalaneni V, Ben-Menachem T, Cash BD, Decker GA, Early DS, Fanelli RD, Fisher DA, Fukami N, Hwang JH, Ikenberry SO, Jue TL, Khan KM, Krinsky ML, Malpas PM, Maple JT, Sharaf RN, Shergill AK, Dominitz JA. Complications of ERCP. Gastrointest Endosc. 2012 Mar;75(3):467-73. [92 references] PubMed|
Not applicable: The guideline was not adapted from another source.
2003 (revised 2012 Mar)
American Society for Gastrointestinal Endoscopy - Medical Specialty Society
American Society for Gastrointestinal Endoscopy
Standards of Practice Committee of the American Society of Gastrointestinal Endoscopy
Committee Members: Michelle A. Anderson, MD; Laurel Fisher, MD; Rajeev Jain, MD; John A. Evans, MD; Vasundhara Appalaneni, MD; Tamir Ben-Menachem, MD; Brooks D. Cash, MD; G. Anton Decker, MD; Dayna S. Early, MD; Robert D. Fanelli, MD (SAGES Representative); Deborah A. Fisher, MD, MHS; Norio Fukami, MD; Joo Ha Hwang, MD; Steven O. Ikenberry, MD; Terry L. Jue, MD; Khalid M. Khan, MD (NASPGAN Representative); Mary Lee Krinsky, DO; Phyllis M. Malpas, RN, CGRN (SGNA Representative); John T. Maple, DO; Ravi N. Sharaf, MD; Amandeep K. Shergill, MD; Jason A. Dominitz, MD, MHS (Chair)
The following authors disclosed financial relationships relevant to this publication: Dr Evans: consultant to Cook Medical; Dr Decker: consultant to Facet Biotechnology. All other authors disclosed no financial relationships relevant to this publication.
This is the current release of the guideline.
This guideline updates a previous version: Mallery JS, Baron TH, Dominitz JA, et al. Complications of ERCP. Gastrointest Endosc 2003;57:633-8.
Electronic copies: Available from the American Society for Gastrointestinal Endoscopy Web site .
Print copies: Available from the American Society for Gastrointestinal Endoscopy, 1520 Kensington Road, Suite 202, Oak Brook, IL 60523
This NGC summary was completed by ECRI Institute on August 20, 2012.
This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.
The National Guideline Clearinghouse™ (NGC) does not develop, produce, approve, or endorse the guidelines represented on this site.
All guidelines summarized by NGC and hosted on our site are produced under the auspices of medical specialty societies, relevant professional associations, public or private organizations, other government agencies, health care organizations or plans, and similar entities.
Guidelines represented on the NGC Web site are submitted by guideline developers, and are screened solely to determine that they meet the NGC Inclusion Criteria.
NGC, AHRQ, and its contractor ECRI Institute make no warranties concerning the content or clinical efficacy or effectiveness of the clinical practice guidelines and related materials represented on this site. Moreover, the views and opinions of developers or authors of guidelines represented on this site do not necessarily state or reflect those of NGC, AHRQ, or its contractor ECRI Institute, and inclusion or hosting of guidelines in NGC may not be used for advertising or commercial endorsement purposes.
Readers with questions regarding guideline content are directed to contact the guideline developer.