BILIARY OBSTRUCTION DUE TO CLOTS, A NEW POST-ERCP COMPLICATION bscarrenom@gmail.com

311-06

BILIARY OBSTRUCTION DUE TO CLOTS, A NEW POST-ERCP COMPLICATION

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Chile

Oral or Poster

Endoscopic retrograde cholangiopancreatography (ERCP) is a minimally invasive procedure used in the diagnosis and treatment of biliopancreatic pathologies. Although generally safe, it has a complication rate of 5% to 10% (pancreatitis, cholangitis, intraluminal bleeding, perforation) and a mortality rate of 0.1% to 1%. Bile duct obstruction by post-ERCP clots is rare. Aim: To describe the clinical presentation, management, and outcomes of five patients who developed this complication.

We conducted a retrospective descriptive study of five consecutive patients who developed biliary obstruction due to clots following ERCP, performed as part of the management of acute cholecystitis and choledocholithiasis. Data were obtained from institutional medical records.

Four women and one man (aged 19 to 89 years) underwent cholecystectomy using the rendez-vous technique and papillotomy with stone extraction. The interval between ERCP and symptom onset—including abdominal pain and cholestatic liver function test abnormalities—ranged from 24 to 96 hours. Imaging (MR or CT) revealed biliary dilation with an obstructive clot. All patients required repeat ERCP for clot removal; one required biliary stent placement. One patient developed severe acute pancreatitis and died of multi-organ failure. Another experienced recurrent hemobilia, requiring angiographic intervention and surgical sphincteroplasty to control bleeding. The overall mortality rate was 20%.

Biliary obstruction due to post-ERCP clots is a rare but potentially life-threatening complication that warrants early suspicion. MRCP and endoscopy facilitate prompt diagnosis and treatment. This entity should be recognized and incorporated into the post-ERCP complication management algorithm.