Abstract
Although endoscopic retrograde cholangiopancreptography (ERCP) has been widely accepted in the diagnosis of pancreatic and biliary tract diseases, complications associated with ERCP have been reported occasionally. The complications are categorized in terms of those attributed to instrumentation and those caused by injection of a radioopaque contrast material into the biliary tree or pancreas. Among them, biliary tract infection is most dangerous. To prevent biliary tract infection after ERCP, complete sterilization is required. The outside and biopsy channel of duodenoscope should be washed repeatedly with soap solution, 70% alcohol, 2% glutaraldehyde and water in this order. A manometer for monitoring injection pressure and cannula are sterilized with ethylene oxide (Table 1). The authors recommend not only routine administration of antibiotics or chemotherapeutics, but also the use of these agents mixed into the injectate. In the last 9 years, 1477 ERCPs were performed at our institution. Of 1477 cases, ERCP and ERC alone were achieved in 657 cases. Biliary tract infection following ERCP was observed in 7 (1.1%) of the 657 cases. No serious complications have been encountered. Biliary tract infection was complicated with ERCP in 2.2% of the initial 185 procedures without use of a chemotherapeutics (thiamphenicol) mixed into the injectate but in 0.6% of the subsequent 472 procedures in which this was applied. Patients with bile duct obstruction demonstrated by ERCP (Fig. 3) should be treated surgically for decompression, to avoid subsequent infection. In patients with obstructive jaundice, ERCP should be performed after having improved jaundice by an external biliary drainage (Fig. 4).
