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Complications. Complications of ERCP and ES occur in 5% to 8% of cases, and some can be serious, with mortality rates of 0.2% to 0.5%. They include the following:
- Pancreatitis (inflammation of the pancreas) occurs in 3% to 9% of cases and can be very serious. Younger adults are at higher risk than the elderly. The risk is also higher with more complex procedures. The drugs somatostatin or gabexate are sometimes used to reduce the risk. Gabexate appears to be more effective, although studies are mixed on whether its benefits are significant, particularly with short-term administration. (Evidence suggests that somatostatin does not reduce this risk.)
- Post-operative infection. Antibiotics may be given before the procedure to prevent infection, although one study reported that they had little benefit.
- Bleeding occurs in 2% of cases. There is an increased risk in patients taking anti-clotting drugs and those who have cholangitis. This complication is treated by flushing the area with epinephrine.
- Perforations (rare).
- Long-term complications include stone recurrence and abscesses.
ERCP and ES are difficult procedures and patients must be certain their doctor and the medical center are experienced with them. The surgeon should have performed at least 180 ERCPs. Under such circumstances, ERCP can usually be performed successfully even in critically ill patients on mechanical ventilators.
ERCP and Gallbladder Removal (Cholecystectomy). ERCP is often performed after gallstones in the common duct are discovered during cholecystectomy (removal of the gallbladder).
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In some cases, stones in the gallbladder are detected during ERCP. In such cases laparoscopic cholecystectomy is usually warranted. There is some debate about whether the gallbladder should be removed in such cases at the same time as ERCP or if patients should wait. A 2002 study suggested that immediate gallbladder removal is preferred, since the risk for recurring symptoms is very high.
Laparoscopic Exploration and Cholangiography
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