ERCP Complications: Infection and Post-ERCP Pancreatitis

Though relatively uncommon, people who undergo an endoscopic retrograde cholangiopancreatography (ERCP)—a medical procedure that uses an endoscope and X-rays to examine and treat problems in the liver, gallbladder, bile ducts and pancreas—may experience complications after the procedure.

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the most common risks of ERCP, not including sedative-related risks, include:

• Pancreatitis;
• Infection of the bile ducts or gallbladder;
• Excessive bleeding (hemorrhage); and
• Perforation of the bile ducts, pancreatic ducts or duodenum (the first part of the small intestine).

These complications occur in about five to 10 percent of ERCP procedures and generally require hospital treatment.

Some of the symptoms of serious complications to look out for following an ERCP include:

• Bloody or black, tar-colored stool;
• Fever;
• Severe chest or abdominal pain;
• Trouble breathing;
• Worsening throat pain or trouble swallowing; and
• Vomiting, especially if the vomit is bloody or looks like coffee grounds.

If you experience any of these symptoms, you should seek medical care immediately.

Pancreatitis is inflammation of the pancreas, the gland responsible for producing insulin and digestive enzymes, and the condition can be either acute or chronic. Generally, acute pancreatitis has a sudden onset and can usually be completely cured with proper treatment. Depending on the severity of the case, some people who experience acute pancreatitis may require hospital care. Chronic pancreatitis, on the other hand, is a long-lasting condition that has no known cure and tends to worsen over time.

Post-ERCP pancreatitis is generally acute, according to a 2021 review published in the World Journal of Gastroenterology (WJG). The symptoms of acute pancreatitis commonly include:

• Pain beginning slowly or suddenly in the upper abdomen, sometimes spreading to the back;
• Fever;
• Nausea and vomiting;
• Fast heartbeat (tachycardia); and
• Swollen or tender abdomen.

The WJG study notes that one of the two most important factors that can lead to post-ERCP pancreatitis is “mechanical injury due to instrumentation.”

Lawsuits are currently being filed alleging that defects in endoscopes made by a leading manufacturer, Olympus, can lead to various severe post-op complications. If you or a loved one developed pancreatitis after ERCP or experienced another complication, visit our main Olympus scope lawsuit page to learn more about your eligibility for a lawsuit, or fill out the form on this page to get in touch.

Another potential complication following ERCP is infection of the bile ducts or gallbladder.

Infection of the bile ducts can lead to cholangitis, which is inflammation of the bile duct system. According to Johns Hopkins Medicine, symptoms of cholangitis commonly include:

• Pain in the upper right part of the abdomen;
• Fever;
• Chills;
• Loss of appetite;
• Jaundice;
• Nausea and vomiting;
• Clay-colored stool;
• Dark urine;
• Low blood pressure;
• Lethargy; and
• Being less alert than usual.

A similar and often related complication that can occur post-ERCP is cholecystitis, which is inflammation of the gallbladder. Cholecystitis, per Cleveland Clinic, is most commonly caused by gallstones but can also be caused by infection or other bile duct blockages.

Symptoms of cholecystitis commonly include:

• Upper abdominal pain (particularly on the upper right side);
• Nausea and vomiting, or in cases with milder symptoms, loss of appetite and feeling unwell;
• Fever;
• Abdominal bloating and tenderness;
• Abdominal muscle stiffness on the right side; and
• Weakness and fatigue, especially in older people.

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