ERCP Infection

Endoscopic retrograde cholangiopancreatography, or ERCP, can be used to treat medical problems caused by abnormalities in the pancreatic or bile ducts. However, medical professionals and patients should be aware of the risks and complications involved with an ERCP procedure. Side effects such as bleeding, pancreatitis, and infection after ERCP may occur.

Infection after ERCP

Infection after an ERCP procedure is one of the most common causes of death after ERCP. It typically occurs in patients with obstructed bile or pancreatic ducts that have not been adequately drained of bile or pancreatic fluid during the procedure. This stagnant bile is more susceptible to infection after ERCP.

ERCP Infection Symptoms

The primary symptom of infection after ERCP is pain in the abdomen. This pain typically occurs in the upper right or middle section of the abdomen. This abdominal pain may resonate to the back or underneath the right shoulder blade. The pain may be steady and dull or sudden, sharp, and cramping.

Patients who develop infection after ERCP typically exhibit symptoms of their bodies fighting the infection. White blood cells help to fight infection. Therefore, medical professionals may observe an increase in the number of white blood cells.

Other symptoms of ERCP infections involve:

  • Fever and chills
  • Nausea and vomiting
  • Clay-colored stools
  • Darkened urine
  • Jaundice, or yellowing of the eyes and skin

Types of ERCP Infections

There are several types of ERCP infections and correlating causes. Many ERCP infections result from some form of blockage, which is one of the reasons a patient may undergo an ERCP procedure to begin with. Other infections may result from ERCP organ perforation.


Cholangitis is an infection that causes inflammation of the common bile duct. Bile is a liquid produced in the liver that aids in food digestion. The common bile duct is a tube-like organ that transmits bile to the gallbladder and intestines from the liver. This infection after ERCP is often caused by a blockage or obstruction in the common bile duct.


Cholecystitis is an infection that causes the inflammation of the gallbladder. This infection after ERCP occurs when bile is trapped inside the gallbladder. This buildup causes pressure and irritation in the gallbladder. In extreme cases, the gallbladder may experience perforation, or a hole in the outer wall.

CRE Infection

A new problem associated with ERCP infections has recently emerged in some of America’s largest cities. There have been several outbreaks of Carbapenem-Resistant Enterobacteriaceae (CRE) infections in large metropolitan cities such as Chicago, Seattle, and most recently, Los Angeles.

CRE outbreaks are particularly alarming since CRE is resistant to the strongest-known antibiotics. CRE outbreaks have been associated with the duodenoscopes used in ERCP procedures, often due to the high volume of procedures prescribed by hospitals, despite the known inability to sterilize the scopes from patient to patient.

Other Infections and Causes

Dead tissue in the pancreas or other organs may also cause infection after ERCP. In cases of severe pancreatic inflammation, blood flow may be restricted from reaching tissue. This leads to pancreatic necrosis, or tissue death in the pancreas. Infected pancreatic necrosis may lead to septic shock and death if left untreated.

Infection after ERCP may also be caused by bacteria introduced during the procedure. During an ERCP, an endoscope is inserted into the mouth and through the esophagus to the biliary tract. If the endoscope is unsanitized, the bacteria may spread and grow.

Treating ERCP Infection

Since infection after ERCP is caused by bacteria, antibiotics are the primary form of treatment. Medical professionals will also attempt to identify and manage the biliary blockage. If bile buildup is still present, drainage should be restored to normal. Severe cholecystitis may require cholecystectomy, or gallbladder removal surgery. Cholecystectomy is often used when gallstones are identified.

Patients who develop infection after ERCP may also receive intravenous (IV) fluids to ensure proper hydration. Pain medication may be administered. A low-fat diet is often recommended to place minimal stress on the biliary system during digestion.


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Salehimarzijarani, Babak, et al. “Risk Factors for Post-ERCP Cholangitis in Patients with Pancreatic Cancer from a Single Referral Center in Iran.” Asian Pacific Journal of Cancer Prevention. 13. (2012): 1539-1541. Web. 4 Jul. 2013. < 5.20 Salehimarzijarani.pdf>.