Narayana Subramaniam^1,, Ashwini Kumar Kudari¹, Balakrishna Mallu Naik¹

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