Pancreatitis after ERCP

Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure used to diagnose and treat disorders involving the pancreatic and bile ducts. One of the most common serious ERCP side effects is pancreatitis after ERCP. It is estimated that pancreatitis after ERCP affects roughly three to 10 percent of patients. In mild forms, pancreatitis after ERCP may resolve itself. However, severe cases of pancreatitis after ERCP can cause death.

What is Pancreatitis?

Pancreatitis is the inflammation of the pancreas. Pancreatitis occurs when a patient experiences elevated levels of enzymes in the pancreas. The American Society for Gastrointestinal Endoscopy defines pancreatitis after ERCP as a threefold increase in pancreatic enzymes. This increase is present for more than 24 hours after the procedure. Pancreatitis after ERCP is one of the most-feared ERCP complications due to its potential for hospitalization, morbidity, and death.

ERCP Pancreatitis Symptoms

Common symptoms for pancreatitis after ERCP may include:

  • Abdominal pain that burns and radiates to the back
  • Tenderness in the abdomen
  • Nausea and vomiting that may worsen with eating
  • Fever and jaundice, or yellowing of the eyes and skin
  • Internal bleeding
  • Elevated blood pressure due to pain
  • Decreased blood pressure due to bleeding or dehydration
  • Elevated respiratory and heart rates

Causes of Pancreatitis after ERCP

Evidence shows a number of conditions or incidences that may cause pancreatitis after ERCP. Pancreatitis after ERCP may occur if the patient experiences mechanical injury during the procedure. This may include prolonged manipulation of the ducts or surrounding organs, injections of a contrast medium to aid X-ray results, and difficulty during cannulation.

Cannulation involves inserting a cannula, or tube-like instrument, into a duct or sphincter to drain bile or pancreatic fluid. Post-ERCP infection and allergic reaction to chemicals or instruments may also cause pancreatitis after ERCP.

Endoscopic Sphincterotomy

Endoscopic sphincterotomy is a common cause of pancreatitis after ERCP. This procedure is typically performed during an ERCP procedure after a diagnosis is made. Endoscopic sphincterotomy involves several types of instruments being inserted through the endoscope, or tube-like instrument, that is inserted during ERCP. The sphincter, or group of muscles that controls the flow of pancreatic fluid and bile, is cut or stretched.

This allows the removal of stones. Additionally, this process allows the medical professional to stretch the narrowed areas of the patient’s pancreatic or biliary ducts. A stent, or drain, may be inserted to prevent the narrowed region from returning to its narrowed state.

Pancreatitis after ERCP Risk Factors

Patients may be more likely to develop pancreatitis after ERCP if they:

  • Are younger or female
  • Have a history of pancreatitis after ERCP
  • Undergo a procedure that involves injection of a contrast medium, or dye
  • Undergo a procedure that involves cannulation
  • Experience dysfunction in the sphincter of Oddi, or the group of muscles controlling the flow of bile and pancreatic fluid




Dugdale, David, ed. “Acute Pancreatitis.” The New York Times. The New York Times Company, 20 Jan 2010. Web. 26 Jun 2013. <>.

Flati, Giancarlo, et al. “Potentially fatal bleeding in acute pancreatitis: pathophysiology, prevention, and treatment..” Pancreas. 26.1 (2003): 8-14. Web. 26 Jun. 2013. <>.

Lehman, Glen A., et al. “Risk Factors for Post-ERCP Pancreatitis: A Prospective Multicenter Study.” The American Journal of Gastroenterology 101.1 (2006): 139-147. MEDLINE with Full Text. Web. 26 June 2013.

“Pancreatitis.” National Digestive Diseases Information Clearinghouse (NDDIC). National Institute of Diabetes and Digestive and Kidney Diseases. Web. 26 Jun 2013. <>.

“Pancreatitis.” University of Maryland Medical Center. University of Maryland. Web. 26 Jun 2013. <>.