Bleeding after ERCP

Endoscopic retrograde cholangiopancreatography (ERCP) is a diagnostic and therapeutic procedure for conditions that affect the ducts which drain the liver and pancreas. Before performing an ERCP procedure, physicians and patients should be aware of the potential complications such as bleeding after ERCP.

ERCP Bleeding

Bleeding after ERCP is a life-threatening complication that can occur during or after a procedure. Some cases of bleeding after ERCP become apparent within two house of the procedure. However, bleeding after ERCP can be delayed and may not become apparent until more than 24 hours after the procedure. Several different factors can cause bleeding after ERCP. Common causes of bleeding after ERCP include sphincterotomy, pancreatitis, and accidental perforation of the patient’s organs.

Sphincterotomy Bleeding after ERCP

It is estimated that roughly half of bleeding after ERCP cases are caused by a sphincterotomy procedure. During a sphincterotomy, the physician cuts the papilla, or opening of the duct. By cutting the papilla, the opening becomes larger so that treatment can be administered, such as removal of a stone or insertion of a stent. The cut is made using a specialized catheter that delivers an electric current.

Pancreatitis Bleeding after ERCP

Pancreatitis after ERCP is a relatively common complication. Depending on the severity, pancreatitis after ERCP may be life-threatening. Severe pancreatic inflammation can cause bleeding after ERCP. Additionally, the growth of abscesses and pseudocysts near the pancreas can cause the erosion and rupture of blood vessels. This can lead to massive internal bleeding after ERCP and should be treated as a medical emergency.

ERCP Organ Perforation

During an ERCP procedure, organ perforation may occur. Perforation occurs when the wall of a hollow organ is completely penetrated by a tool used during the procedure. Perforation typically leaves holes, tears, or puncture wounds in the organ wall. Organ perforation may lead to hemorrhage and bleeding after ERCP. Perforations may occur in organs such as the patient’s bile or pancreatic ducts, duodenum, esophagus, liver, or spleen.

It is estimated that organ perforation occurs in less than one percent of ERCP patients. Bleeding after ERCP perforation can be deadly depending on the severity of the perforation and the amount of time that passes before it is discovered. In cases where organ perforation occurs, the mortality rate is an estimated 16-to-18 percent.

Treatment for Bleeding after ERCP

If bleeding after ERCP is caused by damage to an artery, the patient may require surgery or embolization. Embolization involves using a blood clot, gas bubble, or globule of fat to block a blood vessel and prevent further bleeding. If bleeding after ERCP affects veins, treatment can usually be administered during the initial ERCP procedure. Treatment may include injection of the hormone epinephrine, venous blockage using a balloon, or heat therapy. Patients should continue to be monitored to ensure that the cause of bleeding after ERCP is fully corrected.


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