ERCP Risk Factors

Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure used to diagnose and treat conditions affecting the bile and pancreatic ducts. While ERCP can be extremely effective for certain conditions, caution should be advised. ERCP side effects can be life-threatening. Doctors and patients should be aware of ERCP risk factors that may increase the risk of ERCP side effects.

Common ERCP Risk Factors

ERCP can be used solely to diagnose bile duct conditions. However, ERCP procedures are most commonly recommended to diagnose suspected conditions that can also be treated during the same procedure. ERCP risk factors are significantly increased when the patient receiving treatment during the procedure. Evidence also shows certain ERCP risk factors for specific complications, such as pancreatitis after ERCP.

Sphincter of Oddi Dysfunction

Research shows that sphincter of Oddi dysfuction is among the major ERCP risk factors for complications like pancreatitis. The sphincter of Oddi is a muscular valve that controls the flow of bile and pancreatic juices from the common bile duct and pancreatic duct. Sphincter of Oddi dysfunction causes the patient’s bile or pancreatic juices to build up and cause complications.

Biliary Sphincterotomy

A biliary sphincterotomy procedure is often used to remove bile duct stones or other blockages. During a biliary sphincterotomy, the doctor makes a small incision in the sphincter of Oddi. Cameras are used so that the doctor can visualize and extract the cause of the blockage. A cannula, or specialized tube, is inserted into the bile duct to release built-up bile.

Biliary sphincterotomy presents increased ERCP risk factors such as bleeding and hemorrhage. Many patients who undergo a biliary sphincterotomy are also statistically more likely to develop pancreatits after ERCP. This procedure is also presents ERCP risk factors for organ perforation, or punctures and tears in the walls of involved organs.

ERCP Complications

Pancreatitis after ERCP

Pancreatitis after ERCP is one of the most common ERCP side effects. It is estimated that roughly three to 10 percent of ERCP patients develop pancreatitis after ERCP. Pancreatitis after ERCP can range from mild to life-threatening. In severe cases, pancreatitis after ERCP has caused death. Doctors and patients should be mindful of ERCP risk factors for pancreatitis.

ERCP risk factors for pancreatitis include:

  • Previous post-ERCP pancreatitis
  • Sphincter of Oddi dysfunction
  • Biliary sphincterotomy
  • Injection of contrast dye to aid X-rays
  • Difficulty during cannula insertion
  • Female gender


Infections after ERCP include cholecystitis and cholangitis. Cholecystitis is the infection of the common bile duct. Cholangitis is the inflammation of the gallbladder. Both conditions are considered medical emergencies and should be treated as soon as possible.

ERCP risk factors for cholecystitis and cholangitis include:

  • Pregnancy
  • Female sex
  • Obesity
  • Certain medications
  • Rapid weight loss
  • Mexican-American or Native American ethnicity




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