Since the introduction of endoscopic retrograde cholangiopancreatography (ERCP) in the 1960s, a new field for treating biliary and pancreatic diseases has emerged. With the accumulation of medical materials science, imaging, and clinical experience, medical ERCP is no longer limited to radiography. Treatment techniques related to ERCP, such as sphincterotomy, dilation, and drainage, have gradually begun to emerge and have now become an important means of diagnosis and treatment for biliary and pancreatic diseases. ERCP can be used for the diagnosis and treatment of common bile duct stones, benign and malignant biliary strictures, and pancreatic diseases.
The surgical complications of ERCP are divided into long-term and short-term complications, among which short-term complications are closely related to doctors and patients and need to be paid special attention. The most common and significant short-term complications are bleeding (occurring in 0.3%-2% of cases), perforation (occurring in 0.08%-0.6% of cases), and pancreatitis (occurring in 0.5%-3% of cases). Perforation is the most serious complication. At present, bleeding complications are not a big problem. Basically, through doctors' remedial measures, whether it is re-endoscopy or intervention or surgery, especially with the effective application of current hemostatic clamps, bleeding problems can be controlled. Among the three major complications, post-ERCP pancreatitis (PEP) in ERCP devices due to multiple factors is the most uncontrollable and difficult to treat.
The overall preventive principles for the surgical complications of medical ERCP are to strictly control the surgical indications and improve the operating technology. Post-ERCP pancreatitis often has a significant correlation with improper control of the indications. Top experts in the field of ERCP believe that the patients with the least indications for ERCP actually have the highest risk and are the most likely to have problems and develop pancreatitis. Therefore, the most important issue in preventing complications is to strictly control the indications for ERCP. In addition, the operating technology during the surgery cannot be ignored. Through technology, bleeding problems can be controlled, and to some extent, complications of pancreatitis can also be mitigated.
Due to the special nature of ERCP, many surgeons and gastroenterologists have joined the field. Surgeons may have a stricter grasp of the indications for ERCP devices due to their diverse surgical techniques. Gastroenterologists are often more proficient in endoscopic techniques. Therefore, further communication between the two sides may be needed to prevent complications of ERCP.