ERCP is endoscopic retrograde cholangiopancreatography. That is to say, the catheter is inserted from the duodenal papilla under the endoscope, and when the relevant instruments reach the pancreatic duct and bile duct, the contrast medium is injected into the pancreaticobiliary duct, and the pancreaticobiliary system is observed by X-ray and corresponding operations are performed.
Pancreatitis is the most common postoperative complication in ERCP patients. The etiology included biliopancreatic duct stenosis and previous pancreatic diseases. Risk factors for operation include breast edema, difficult intubation, pre-cutting, nipple spasm caused by repeated intubation, too fast or too much contrast agent injected into the pancreatic duct, pancreas parenchyma development, excessive high-frequency electrocoagulation, stones embedded in the nipple, bacterial infection, high osmotic pressure of contrast medium, etc.
Solution: Antibacterial drugs, CT examination, etc. can be used to prevent post-ERCP pancreatitis. If necessary, pancreatic duct stent implantation can be used for prophylaxis.
Bleeding is the most serious postoperative complication of ERCP patients, with an incidence rate of 0.3% to 2%, including delayed bleeding and early bleeding. Risk factors for bleeding include anticoagulant therapy for 3 days before ERCP, coagulation dysfunction, improper endoscopic operation, too large incision, and too fast nipple incision. High-risk groups of postoperative bleeding include those with severe jaundice, high blood pressure, blood coagulation disorders, and diabetes.
Solution: Endoscopic papillary sphincter balloon dilatation can be used instead of papillary sphincterotomy for patients with high risk of bleeding after ERCP. If bleeding occurs during ERCP, argon ion coagulation, metal clip clamping, electrocoagulation to stop bleeding, and local balloon compression can be used to improve bleeding symptoms.
Complicated perforation after ERCP is also a common phenomenon. Patients with high risk of this complication include: those who have perforation of the lumen caused by the endoscope body have a higher risk of intraperitoneal perforation after ERCP; sphincterotomy has exceeded the pancreatic duct wall or bile duct In some cases, retroperitoneal fistula is prone to occur after ERCP; if the guide wire bile duct stent is displaced or externally punctured, ERCP is prone to perforation. In addition, duodenal lumen perforation is also prone to occur during ERCP, with a risk of 0.08% to 0.6%.
Solution: Once perforation occurs, timely and targeted treatment is required to avoid multiple organ failure and sepsis. In addition, CT detection technology can also be used for diagnosis, but it needs to be scanned after oral contrast agent.
Including duodenal-related infection, cholecystitis, acute cholangitis, etc. Risk factors include: unresolved biliary obstruction, including drainage tube displacement, incomplete drainage of lesions at or above the hepatic hilum, and incomplete removal of stones.
Solution: Antibacterial drugs can be used for preventive treatment, mechanical disinfection and cleaning work should be done well, and operations should be strictly performed in accordance with relevant standards during the operation to reduce the incidence of postoperative infection.