Skip to main content
SpringerLink
Log in

ERCP On-Call Emergencies

  • Chapter
  • First Online:
Advanced Pancreaticobiliary Endoscopy

  • 987 Accesses

Abstract

The common indications for an urgent endoscopic retrograde cholangiopancreatography (ERCP) are acute cholangitis and biliary pancreatitis. In addition, stent migration, trapped or broken retrieval basket, hemobilia, luminal or guidewire perforation, and acute cholecystitis are some other urgent and emergent situations that therapeutic endoscopists are faced with in clinical practice. This chapter reviews management of these conditions focusing on endoscopic techniques.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 69.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 89.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 129.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Reynolds BM, Dargan EL. Acute obstructive cholangitis a distinct clinical syndrome. Ann Surg. 1959;150(2):299–303.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Csendes A, Diaz JC, Burdiles P, Maluenda F, Morales E. Risk factors and classification of acute suppurative cholangitis. Br J Surg. 1992;79:655–8.

    Article  CAS  PubMed  Google Scholar 

  3. Kiriyama S, Takada T, Strasberg SM, Solomkin JS, et al. New diagnostic criteria and severity assessment of acute cholangitis in revised Tokyo Guidelines. J Hepatobiliary Pancreat Sci. 2012;19:548–56.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Mayumi T, Takada T, Kawarada Y, et al. Results of the Tokyo consensus meeting Tokyo guidelines. J Hepatobiliary Pancreat Sci. 2007;14(1):114–21.

    Article  Google Scholar 

  5. Kiriyama S, Takada T, Strasberg SM, et al. TG13 guidelines for diagnosis and severity grading of acute cholangitis (with videos). J Hepatobiliary Pancreat Sci. 2013;20(1):24–34.

    Article  PubMed  Google Scholar 

  6. Ge PS, Hamerski CM, Watson RR, et al. Plastic biliary stent patency in patients with locally advanced pancreatic adenocarcinoma receiving downstaging chemotherapy. Gastrointest Endosc. 2015;81(2):360–6.

    Article  PubMed  Google Scholar 

  7. Gomi H, Solomkin JS, Takada T, et al. TG13 antimicrobial therapy for acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci. 2013;20(1):60–70.

    Article  PubMed  Google Scholar 

  8. Itoi T, Tsuyuguchi T, Takada T, et al. TG13 indications and techniques for biliary drainage in acute cholangitis (with videos). J Hepatobiliary Pancreat Sci. 2013;20(1):71–80.

    Article  PubMed  Google Scholar 

  9. ASGE Standards of Practice Committee. The role of endoscopy in the management of choledocholithiasis. Gastrointest Endosc. 2011;74(4):731–44.

    Article  Google Scholar 

  10. Horiuchi A, Kajiyama M, Ichise Y, et al. Biliary stenting as alternative therapy to stone clearance in elderly patients with bile duct stones. Acta Gastroenterol Belg. 2014;77(3):297–301.

    PubMed  Google Scholar 

  11. Okano N, Igarashi Y, Kishimoto Y, Mimura T, Ito K. Necessity for endoscopic sphincterotomy for biliary stenting in cases of malignant biliary obstruction. Dig Endosc. 2013;25 Suppl 2:122–5.

    Article  PubMed  Google Scholar 

  12. Elmunzer BJ, Scheiman JM, Lehman GA, et al. A randomized trial of rectal indomethacin to prevent post-ERCP pancreatitis. N Engl J Med. 2012;366(15):1414–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Khashab MA, Valeshabad AK, Modayil R, et al. EUS-guided biliary drainage by using a standardized approach for malignant biliary obstruction: rendezvous versus direct transluminal techniques (with videos). Gastrointest Endosc. 2013;78(5):734–41.

    Article  PubMed  Google Scholar 

  14. Tenner S, Baillie J, DeWitt J, Vege SS. American College of Gastroenterology Guideline: Management of acute pancreatitis. Am J Gastroenterol. 2013;108(9):1400–15.

    Article  CAS  PubMed  Google Scholar 

  15. ASGE Standards of Practice Committee. The role of endoscopy in the management of suspected choledocholithiasis. Gastrointest Endosc. 2010;71(1):1–9.

    Article  Google Scholar 

  16. Tseng CW, Chen CC, Chen TS, et al. Can computed tomography with coronal reconstruction improve the diagnosis of choledocholithiasis? J Gastroenterol Hepatol. 2008;23(10):1586–9.

    Article  PubMed  Google Scholar 

  17. Zidi SH, Prat F, Le Guen O, et al. Use of magnetic resonance cholangiography in the diagnosis of choledocholithiasis: prospective comparison with a reference imaging method. Gut. 1999;44:118–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Sugiyama M, Atomi Y, Hachiya J. Magnetic resonance cholangiography using half-Fourier acquisition for diagnosing choledocholithiasis. Am J Gastroenterol. 1998;93:1886–90.

    Article  CAS  PubMed  Google Scholar 

  19. Garrow D, Miller S, Sinha D, et al. Endoscopic ultrasound: a metaanalysis of test performance in suspected biliary obstruction. Clin Gastroenterol Hepatol. 2007;5:616–23.

    Article  PubMed  Google Scholar 

  20. Tse F, Liu L, Barkun AN, et al. EUS: a meta-analysis of test performance in suspected choledocholithiasis. Gastrointest Endosc. 2008;67:235–44.

    Article  PubMed  Google Scholar 

  21. Sugiyama M, Atomi Y. Endoscopic ultrasonography for diagnosing choledocholithiasis: a prospective comparative study with ultrasonography and computed tomography. Gastrointest Endosc. 1997;45:143–6.

    Article  CAS  PubMed  Google Scholar 

  22. Kondo S, Isayama H, Akahane M, et al. Detection of common bile duct stones: comparison between endoscopic ultrasonography, magnetic resonance cholangiography, and helical-computed-tomographic cholangiography. Eur J Radiol. 2005;54:271–5.

    Article  PubMed  Google Scholar 

  23. Scheiman JM, Carlos RC, Barnett JL, et al. Can endoscopic ultrasound or magnetic resonance cholangiopancreatography replace ERCP in patients with suspected biliary disease? A prospective trial and cost analysis. Am J Gastroenterol. 2001;96(10):2900–4.

    Article  CAS  PubMed  Google Scholar 

  24. Folsch UR, Nitsche R, Ludtke R, et al. Early ERCP and papillotomy compared with conservative treatment for acute biliary pancreatitis. N Engl J Med. 1997;336:237–42.

    Article  CAS  PubMed  Google Scholar 

  25. Oria A, Cimmino D, Ocampo C, et al. Early endoscopic intervention versus early conservative management in patients with acute gallstone pancreatitis and biliopancreatic obstruction: a randomized clinical trial. Ann Surg. 2007;245:10–7.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Johanson JF, Schmalz MJ, Geenen JE. Incidence and risk factors for biliary and pancreatic stent migration. Gastrointest Endosc. 1992;38:341–6.

    Article  CAS  PubMed  Google Scholar 

  27. Kawaguchi Y, Ogawa M, Kawashima Y, et al. Risk factors for proximal migration of biliary tube stents. World J Gastroenterol. 2014;20(5):1318–24.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Nakai Y, Isayama H, Kogure H, et al. Risk factors for covered metallic stent migration in patients with distal malignant biliary obstruction due to pancreatic cancer. J Gastroenterol Hepatol. 2014;29(9):1744–9.

    Article  PubMed  Google Scholar 

  29. Arhan M, Odemis B, Parlak E, et al. Migration of biliary plastic stents: experience of a tertiary center. Surg Endosc. 2009;23:769–75.

    Article  PubMed  Google Scholar 

  30. Telford JJ, Carr-Locke DL, Baron TH, et al. A randomized trial comparing uncovered and partially covered self-expandable metal stents in the palliation of distal malignant biliary obstruction. Gastrointest Endosc. 2010;72(5):907–14.

    Article  PubMed  Google Scholar 

  31. Saleem A, Leggett CL, Murad MH, Baron TH. Meta-analysis of randomized trials comparing the patency of covered and uncovered self-expandable metal stents for palliation of distal malignant bile duct obstruction. Gastrointest Endosc. 2011;74(2):321–7.

    Article  PubMed  Google Scholar 

  32. Al-Zubaidi AM, Al-Zubaidi AH, Qureshi LA, AL-Haroon EE. Full length migration of plastic biliary stent into the left lobe of liver and its endoscopic retrieval. J Coll Physicians Surg Pak. 2014;24(11):861–2.

    PubMed  Google Scholar 

  33. Cho NJ, Lee TH, Park SH, et al. Endoscopic removal of a proximally migrated metal stent during balloon sweeping after stent trimming. Clin Endosc. 2013;46(4):418–22.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Santos A, Leitao C, Vieira A, Pereira E. Endoscopic and percutaneous extraction of two biliary stents migrated to distinct abdominal locations. BMJ Case Rep. 2014 Dec 19;2014.

    Google Scholar 

  35. Antonsen J, Preisler L, Skram U, Klein M. Fatal biliary-pulmonary fistula due to a proximally migrating biliary stent. Endoscopy. 2013;45(Suppl 2 UCTN):E265–6.

    PubMed  Google Scholar 

  36. Dasmahapatra HK, Pepper JR. Bronchopleurobiliary fistula. A complication of intrahepatic biliary stent migration. Chest. 1988;94(4):874–5.

    Article  CAS  PubMed  Google Scholar 

  37. Kumar V, Rajalingam R, Saluja SS, Chander Sharma B, Mishra PK. Unusual proximal migration of biliary plastic endoprostheses into the inferior vena cava. Am Surg. 2012;78(12):E520–2.

    PubMed  Google Scholar 

  38. Lee V, Woldman S, Meier P. Biliary stent migration as a cause of cardiac tamponade. J Cardiovasc Med (Hagerstown). 2013;14(10):750–2.

    Article  Google Scholar 

  39. Barut I, Tarhan OR. Cecum perforation due to biliary stent migration. Saudi Med J. 2014;35(7):747–9.

    PubMed  Google Scholar 

  40. El Zein MH, Kumbhari V, Tieu A, et al. Duodenal perforation as a consequence of biliary stent migration can occur regardless of stent type or duration. Endoscopy. 2014;46:E281–2.

    Article  PubMed  Google Scholar 

  41. Kittappa K, Maruthachalam K, Brookstein R, Debrah S. Migrated biliary stent presenting as a sigmoid diverticulitis – case report. Indian J Surg. 2013;75 Suppl 1:253–4.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Toth P, Dvorak J, Marz J. Biliary stent as a cause of bowel obstruction. Rozhl Chir. 2014;93(1):28–30.

    CAS  PubMed  Google Scholar 

  43. Mavrogenis G, Lalot M, Hoebeke Y, et al. Biliary stent migration presenting as a recurrent pilonidal abscess with underlying rectocutaneous fistula. Endoscopy. 2013;45(S 02):E301–2.

    Article  PubMed  Google Scholar 

  44. Katsinelos P, Kountouras J, Paroutoglou G, et al. Migration of plastic biliary stents and endoscopic retrieval: an experience of three referral centers. Surg Laparosc Endosc Percutan Tech. 2009;19(3):217–21.

    Article  PubMed  Google Scholar 

  45. Chaurasia OP, Rauws EA, Fockens P, Huibregtse K. Endoscopic techniques for retrieval of proximally migrated biliary stents: the Amsterdam experience. Gastrointest Endosc. 1999;50(6):780–5.

    Article  CAS  PubMed  Google Scholar 

  46. Lahoti S, Catalano MF, Geenen JE, Schmalz MJ. Endoscopic retrieval of proximally migrated biliary and pancreatic stents: experience of a large referral center. Gastrointest Endosc. 1998;47(6):486–91.

    Article  CAS  PubMed  Google Scholar 

  47. Tarnasky PR, Cotton PB, Baillie J, et al. Proximal migration of biliary stents: attempted endoscopic retrieval in forty-one patients. Gastrointest Endosc. 1995;42(6):513–20.

    Article  CAS  PubMed  Google Scholar 

  48. Goetz M, Walther U, Malek N, Fuchs J, et al. Transpapillary retrieval of a proximally migrated stent using a three-prong polyp retrieval device in a 2-years-old girl. Z Gastroenterol. 2014;52(4):351–3.

    Article  CAS  PubMed  Google Scholar 

  49. Okabe Y, Tsuruta O, Kaji R, et al. Endoscopic retrieval of migrated plastic stent into bile duct or pancreatic pseudocyst. Dig Endosc. 2009;21(1):1–7.

    Article  PubMed  Google Scholar 

  50. Lee JH, Yan SL, Chen CH, Yeh YH, Yueh SK. Endoscopic retrieval of a proximally migrated biliary plastic stent using a guidewire loop technique. Endoscopy. 2014;46(Suppl 1 UCTN):E232–3.

    PubMed  Google Scholar 

  51. Shah DK, Jain SS, Somani PO, Rathi PM. Biliary sphincteroplasty facilitates retrieval of proximally migrated plastic biliary stent. Trop Gastroenterol. 2014;35(2):103–6.

    Article  Google Scholar 

  52. Vázquez Rey MT, González Conde B, Alonso Aguirre PA, et al. Retrieval of proximally migrated plastic biliary stents using a metal stent. Endoscopy. 2011;43(Suppl 2 UCTN):E376.

    Article  PubMed  Google Scholar 

  53. Thomas M, Howell DA, Carr-Locke D, et al. Mechanical lithotripsy of pancreatic and biliary stones: complications and available treatment options collected from expert centers. Am J Gastroenterol. 2007;102(9):1896–902.

    Article  PubMed  Google Scholar 

  54. Draganov P, Cunningham JT. Novel “through-the-endoscope” technique for removing biliary stones trapped in a retrieval basket. Endoscopy. 2002;34(2):176.

    Article  CAS  PubMed  Google Scholar 

  55. Hu LH, Du TT, Liao Z, Zou WB, Ye B, Li ZS. Extracorporeal shock wave lithotripsy as a rescue for a trapped stone basket in the pancreatic duct. Endoscopy. 2014;46(Suppl 1 UCTN):E332–3.

    PubMed  Google Scholar 

  56. Ng EK, Lau JY, Chung SC, Li AK. Retrieval of an impacted mechanical lithotripsy basket. Endoscopy. 1997;29(2):128.

    Article  CAS  PubMed  Google Scholar 

  57. Schutz SM, Chinea C, Friedrichs P. Successful endoscopic removal of a severed, impacted Dormia basket. Am J Gastroenterol. 1997;92(4):679–81.

    CAS  PubMed  Google Scholar 

  58. Freeman ML, Nelson DB, Sherman S, et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med. 1996;335:909–18.

    Article  CAS  PubMed  Google Scholar 

  59. Conio M, Caroli-Bosc FX, Buckley M, et al. Massive hematobilia after extraction of plastic biliary endoprosthesis. J Clin Gastroenterol. 1997;25(4):706.

    Article  CAS  PubMed  Google Scholar 

  60. Goenka MK, Harwani Y, Rai V, Goenka U. Fully covered self-expandable metal biliary stent for hemobilia caused by portal biliopathy. Gastrointest Endosc. 2014;80(6):1175.

    Article  PubMed  Google Scholar 

  61. Marynissen T, Maleux G, Heye S, et al. Transcatheter arterial embolization for iatrogenic hemobilia is a safe and effective procedure: case series and review of the literature. Eur J Gastroenterol Hepatol. 2012;24(8):905–9.

    Article  PubMed  Google Scholar 

  62. Genzlinger JL, McPhee MS, Fisher JK, et al. Significance of retroperitoneal air after endoscopic retrograde cholangiopancreatography with sphincterotomy. Am J Gastroenterol. 1999;94:1267–70.

    Article  CAS  PubMed  Google Scholar 

  63. Kitano M, Yamashita Y, Tanaka K, et al. Covered self-expandable metal stents with an anti-migration system improve patency duration without increased complications compared with uncovered stents for distal biliary obstruction caused by pancreatic carcinoma: a randomized multicenter trial. Am J Gastroenterol. 2013;108(11):1713–22.

    Article  PubMed  Google Scholar 

  64. Itah R, Bruck R, Santo M, Skornick Y, Avital S. Gangrenous cholecystitis - a rare complication of ERCP. Endoscopy. 2007;39 Suppl 1:E223–4.

    Article  PubMed  Google Scholar 

  65. Kim DU, Kang DH, Kim GH, et al. Bilateral biliary drainage for malignant hilar obstruction using the ‘stent-in-stent’ method with a Y-stent: efficacy and complications. Eur J Gastroenterol Hepatol. 2013;25(1):99–106.

    Article  PubMed  Google Scholar 

  66. Saxena P, Singh VK, Lennon AM, et al. Endoscopic management of acute cholecystitis after metal stent placement in patients with malignant biliary obstruction: a case series. Gastrointest Endosc. 2013;78(1):175–8.

    Article  PubMed  Google Scholar 

  67. Isayama H, Kawabe T, Nakai Y, et al. Cholecystitis after metallic stent placement in patients with malignant distal biliary obstruction. Clin Gastroenterol Hepatol. 2006;4(9):1148–53.

    Article  PubMed  Google Scholar 

  68. Shimizu S, Naitoh I, Nakazawa T, et al. Predictive factors for pancreatitis and cholecystitis in endoscopic covered metal stenting for distal malignant biliary obstruction. J Gastroenterol Hepatol. 2013;28(1):68–72.

    Article  PubMed  Google Scholar 

  69. Almadi MA, Barkun AN, Martel M. No benefit of covered vs uncovered self-expandable metal stents in patients with malignant distal biliary obstruction: a meta-analysis. Clin Gastroenterol Hepatol. 2013;11(1):27–37.

    Article  PubMed  Google Scholar 

  70. Tsuyuguchi T, Itoi T, Takada T, et al. TG13 indications and techniques for gallbladder drainage in acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci. 2013;20(1):81–8.

    Article  PubMed  Google Scholar 

  71. Maekawa S, Nomura R, Murase T, Ann Y, Oeholm M, Harada M. Endoscopic gallbladder stenting for acute cholecystitis: a retrospective study of 46 elderly patients aged 65 years or older. BMC Gastroenterol. 2013;13:65.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Widmer J, Singhal S, Gaidhane M, Kahaleh M. Endoscopic ultrasound-guided endoluminal drainage of the gallbladder. Dig Endosc. 2014;26(4):525–31.

    Article  PubMed  Google Scholar 

  73. Teoh AY, Binmoeller KF, Lau JY. Single-step EUS-guided puncture and delivery of a lumen-apposing stent for gallbladder drainage using a novel cautery-tipped stent delivery system. Gastrointest Endosc. 2014;80(6):1171.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Center for Digestive Health, Drexel University, 219 N. Broad Street, 5th Floor, Philadelphia, PA, 19107, USA

    Anand R. Kumar M.D., M.P.H.

  2. Hahnemann University Hospital, Philadelphia, PA, USA

    Anand R. Kumar M.D., M.P.H.

  3. Department of Medicine, Fox Chase Cancer Center, Philadelphia, PA, USA

    Jeffrey L. Tokar M.D., F.A.S.G.E., A.G.A.F.

Authors
  1. Anand R. Kumar M.D., M.P.H.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jeffrey L. Tokar M.D., F.A.S.G.E., A.G.A.F.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anand R. Kumar M.D., M.P.H. .

Editor information

Editors and Affiliations

  1. Salt Lake City, Utah, USA

    Douglas G. Adler

Video Legends

Video 7.1 Cholangitis after prior biliary intervention with a plastic stent (MP4 6163 kb).

Video 7.2 Occluded biliary metal stent with sludge and debris resulting in cholangitis ((MP4 17,547 kb).

Video 7.3 Proximally migrated PD stent retrieved using a rat-tooth forceps (MP4 19,624 kb).

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Kumar, A.R., Tokar, J.L. (2016). ERCP On-Call Emergencies. In: Adler, D. (eds) Advanced Pancreaticobiliary Endoscopy. Springer, Cham. https://doi.org/10.1007/978-3-319-26854-5_7

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-26854-5_7

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-26852-1

  • Online ISBN: 978-3-319-26854-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation