Severe and fatal complications after ERCP: analysis of 2555 procedures in a single experienced center

Surg Endosc. 2008 Sep;22(9):1965-70. doi: 10.1007/s00464-007-9711-0. Epub 2007 Dec 20.


Background and study aims: The majority of recent large series on endoscopic retrograde cholangiopancreatography (ERCP) complications have been multicenter studies reflecting varying degrees of experience and ERCP volume; major ERCP complications are associated with low case volume. The aim of this study was to report and analyze the frequency of severe and fatal complications associated with ERCP at a single specialized surgical high-volume referral center (Turku University Central Hospital).

Methods: All scheduled ERCP procedures (n = 2788) at our unit between January 1997 and December 2005 were included and the procedure-related severe and fatal complications were assessed by retrospective chart review. Complications were classified as severe or fatal according to standardized guidelines.

Results: The number of ERCP procedures performed was 2555, of which 71% were therapeutic and 29% were diagnostic. Seventeen (0.8%) severe complications were identified in 16 patients, of whom 15 underwent a therapeutic endoscopic procedure. Of the 17 severe complications, perforation constituted five cases (0.2%), pancreatitis occurred in five patients (0.2%), bleeding in five cases (0.2%), and two patients suffered from purulent cholangitis (0.1%). Procedure-related mortality was 0.08% (n = 3).

Conclusions: In our study the rate of severe or fatal complications of ERCP is low in experienced hands at a high-volume center, comparing favorably to corresponding complication rates of multicenter series, which further supports the importance of centralizing ERCP procedures in high-volume advanced centers.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cardia / injuries
  • Cause of Death
  • Cholangiopancreatography, Endoscopic Retrograde / adverse effects*
  • Cholangiopancreatography, Endoscopic Retrograde / mortality
  • Cholangitis / epidemiology
  • Cholangitis / etiology
  • Duodenum / injuries
  • Female
  • Hemorrhage / epidemiology
  • Hemorrhage / etiology
  • Hospital Mortality
  • Humans
  • Intestinal Perforation / epidemiology
  • Intestinal Perforation / etiology
  • Male
  • Middle Aged
  • Pancreatitis / etiology
  • Pancreatitis / mortality
  • Retrospective Studies
  • Sepsis / etiology
  • Sepsis / mortality
  • Shock, Hemorrhagic / etiology
  • Shock, Hemorrhagic / mortality
  • Sphincterotomy, Endoscopic / adverse effects*
  • Sphincterotomy, Endoscopic / mortality
  • Treatment Failure