Global Journal of Surgery
ISSN (Print): 2379-8742 ISSN (Online): 2379-8750 Website: Editor-in-chief: Baki Topal
Open Access
Journal Browser
Global Journal of Surgery. 2015, 3(1), 12-16
DOI: 10.12691/js-3-1-4
Open AccessCase Report

Complications of Endoscopic Retrograde Cholangiopancreatography Requiring Surgical Intervention: One-Year Experience in A Tertiary Care Centre

Narayana Subramaniam1, , Ashwini Kumar Kudari1 and Balakrishna Mallu Naik1

1Department of General Surgery, MS Ramaiah Medical College & Hospital, Bangalore, India

Pub. Date: March 19, 2015

Cite this paper:
Narayana Subramaniam, Ashwini Kumar Kudari and Balakrishna Mallu Naik. Complications of Endoscopic Retrograde Cholangiopancreatography Requiring Surgical Intervention: One-Year Experience in A Tertiary Care Centre. Global Journal of Surgery. 2015; 3(1):12-16. doi: 10.12691/js-3-1-4


Aim: To study the complications of endoscopic retrograde cholangiopancreaticography requiring surgical intervention in a tertiary care centre, occurring during a one year period. Background: ERCPs are a commonly performed, safe, diagnostic and therapeutic modality routinely used for evaluation of pancreatico-biliary pathologies. Most complications are mild and resolve with conservative medical management. This article focuses on those complications that required emergency surgical intervention, surgical techniques employed, difficulties associated with management and post-operative complications. Materials & Methods: Between March 2012 and February 2013, a total of 710 ERCPs were performed at M.S. Ramaiah Hospital for a variety of indications. All data with respect to procedure were collected – indications, whether ERCP was diagnostic or therapeutic, nature of intervention performed, post-procedural complications, subsequent hospitalisation, length of hospital stay and management of complications, whether medical or surgical. Results: Four major complications (0.56%) occurred, requiring surgical intervention – two duodenal perforations, one case of an ERCP basket becoming trapped within the common bile duct and a case of gastric outlet obstruction following pancreatic duct stent migration. The first three complications were noted during the procedure and the last was diagnosed on follow-up one month later. Other complications included 12 cases of moderate to severe pancreatitis (1.69%), 16 cases of cholangitis (2.25%) and 3 cases of haemorrhage (0.42%). Discussion: Major complications of ERCP, though rare, cause significant morbidity, and occasionally mortality. This article discusses the risk factors, incidence of major complications and detailed surgical management of these conditions, including technical difficulties associated with these surgeries, post-operative pitfalls and their management. Additionally, our data is compared and contrasted with similar literature.

ERCP perforation complications surgery

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit


[1]  Cotton PB, Lehman G et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endoscopy 1991; 37: 383-393.
[2]  Machado NO. Management of duodenal perforations post ERCP. When and whom to operate and what factors determine the outcome: a review article. Journal of the Pancreas 2011; 13 (1): 19-25.
[3]  Stapfer M, Selby RR, Stain SC, et al. Management of duodenal perforation after endoscopic retrograde cholangiopancreatography and sphincterotomy. Ann Surg. 1999; 232 (2): 191-8.
[4]  Loperfido S, Angelini G, Benedetti G, et al. Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study. Gastrointest Endosc. 1998; 48 (1): 1-10
[5]  Freeman ML, Nelson DB, Sherman S et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med 1996; 335: 909-18
[6]  Howard TJ, Tan T, Lehman GA, et al. Classification and management of perforations complicating endoscopic sphincterotomy. Surgery 1999; 126:658.
[7]  V. Thill, C. Simoens, and P. Mendes da Costa. Management of iatrogenic perforation after gastrointestinal endoscopy. Hepato-Gastroenterology, vol. 57, no. 104, pp. 1465-1468, 2010.
[8]  L. Fujii, A. Lau,D. E. Fleischer, and M. E. Harrison. Successful nonsurgical treatment of pneumomediastinum, pneumothorax, pneumoperitoneum, pneumoretroperitoneum, and subcutaneous emphysema following ERCP. Gastroenterology Research and Practice, vol. 2010, Article ID 289135, 2010
[9]  H. M. Wu, E. Dixon, G. R. May, and F. R. Sutherland. Management of perforation after endoscopic retrograde cholangiopancreatography (ERCP): a population-based review. HPB, 2006 (8): 393-9.
[10]  K. A. Morgan, B. B. Fontenot, J. M. Ruddy, S. Mickey, and D. B. Adams. Endoscopic retrograde cholangiopancreatography gut perforations: when to wait! When to operate! The American Surgeon, 2009; 75 (6): 477-483.
[11]  M. Ercan, E. B. Bostanci, T. Dalgic et al. Surgical outcome of patients with perforation after endoscopic retrograde cholangiopancreatography. Journal of Laparoendoscopic and Advanced Surgical Techniques A. 2012 (224): 371-7.
[12]  A. Guitron-Cantu, R. Adalid-Martınez, J. A. Gutierrez-Bermudez, A. Nieves-Renterıa, and G. Alvarez-Vald´es. Complications in diagnostic and therapeutic endoscopic cholangiopancreatography. Prospective study. Revista de Gastroenterologıa de Mexico. 2007 (72): 227-235.
[13]  A. Assalia, A. Suissa, A. Ilivitzki et al. Validity of clinical criteria in the management of endoscopic retrograde cholangiopancreatography-related duodenal perforations. Archives of Surgery, 2007 (142): 1059-64.
[14]  Stapfer, Selby et al. Management of duodenal perforations after ERCP and sphincterotomy. Annals of Surgery. 2000; 232 (2): 191-8.
[15]  Masci E., Toti G., Mariani A. Complications of diagnostic and therapeutic ERCP: a prospective multicenter study. American Journal of Gastroenterology. 2001 (96): 417-23.
[16]  The Victoria Surgical Consultative Council (VSCC) guidelines. Complications of ERCP; 2007.