Barakat Monique, Saumoy Monica, Forbes Nauzer, Elmunzer B Joseph
Divisions of Pediatric and Adult Gastroenterology & Hepatology, Departments of Pediatrics and Medicine, Stanford University School of Medicine, Palo Alto, California.
Center for Digestive Health, Penn Medicine Princeton Health, Princeton, New Jersey.
Gastroenterology. 2025 Aug;169(2):230-243.e8. doi: 10.1053/j.gastro.2025.03.009. Epub 2025 Mar 20.
Up to 1 in 6 patients will experience an unplanned hospitalization after endoscopic retrograde cholangiopancreatography (ERCP), largely for the evaluation and management of adverse events. Therefore, a commitment to the prevention, early recognition, and effective rescue of complications related to ERCP is critical toward improving outcomes. ERCP is most often complicated by acute pancreatitis, bleeding, infection, or perforation, although myriad other adverse events may occur. The prevention of post-ERCP pancreatitis has been the area of greatest interest and progress in the last decade, but the application of evidence-based prophylactic measures remains inconsistent. Innovations in stent, hemostasis, and perforation closure technology now allow effective and efficient endoscopic management of several important nonpancreatitis complications. Overall, our ability to prevent and treat ERCP-related adverse events has improved substantially, amplifying the importance of a high level of suspicion for and a thorough understanding of these events.
