Adverse Events Associated With Endoscopic Retrograde Cholangiopancreatography: Systematic Review and Meta-Analysis

Kirles Bishay; Zhao Wu Meng; Rishad Khan; Mehul Gupta; Yibing Ruan; Marcus Vaska; Jordan Iannuzzi; Dylan E. O'Sullivan; Brittany Mah; Arun C.R. Partridge; Amanda M. Henderson; Howard Guo; Sunil Samnani; Max DeMarco; Yuhong Yuan; B. Joseph Elmunzer; Rajesh N. Keswani; Sachin Wani; Zachary L. Smith; Ronald J. Bridges; Steven J. Heitman; Robert J. Hilsden; Darren R. Brenner; Grigorios I. Leontiadis; Nauzer Forbes

doi:10.1053/j.gastro.2024.10.033

Adverse Events Associated With Endoscopic Retrograde Cholangiopancreatography: Systematic Review and Meta-Analysis

Kirles Bishay, Zhao Wu Meng, Rishad Khan, Mehul Gupta, Yibing Ruan, Marcus Vaska, Jordan Iannuzzi, Dylan E. O'Sullivan, Brittany Mah, Arun C.R. Partridge, Amanda M. Henderson, Howard Guo, Sunil Samnani, Max DeMarco, Yuhong Yuan, B. Joseph Elmunzer, Rajesh N. Keswani, Sachin Wani, Zachary L. Smith, Ronald J. BridgesSteven J. Heitman, Robert J. Hilsden, Darren R. Brenner, Grigorios I. Leontiadis, Nauzer Forbes^*

^*Corresponding author for this work

Medicine, Gastroenterology Division

Research output: Contribution to journal › Article › peer-review

5 Scopus citations

Abstract

Background & Aims: Endoscopic retrograde cholangiopancreatography (ERCP)–related adverse events (AEs) are associated with morbidity, mortality, and health care expenditure. We aimed to assess incidences and comparisons of ERCP AEs. Methods: We included studies performed after 2000 reporting on ERCP AEs from database inception through March 12, 2024. Outcomes included pancreatitis, bleeding, cholangitis, cholecystitis, perforation, and death. DerSimonian and Laird random effects meta-analyses were performed to calculate incidences of AEs. Subgroup and pairwise meta-analyses were performed. Meta-regression was performed on median recruitment year to assess temporal trends in pancreatitis incidence. Results: A total of 380 studies were included. The incidence of death attributable to ERCP was 0.2% (95% confidence interval [CI], 0.1%–0.3%; I², 44%; n = 47,258) in all-comers. The overall incidence of pancreatitis was 4.6% (95% CI, 4.0%–5.1%; I², 96%; n = 293,378) among all-comers and 6.5% (95% CI, 5.9%–7.1%, I², 89%; n = 88,809) among first-time patients. Pancreatitis incidence remained stable between 2000 and 2023 (average annual percent change 0.06, 95% CI, −0.27 to 0.39). The overall incidences of the following AEs for all-comers were: bleeding (1.5%; 95% CI, 1.2%–1.7%; I², 93%; n = 229,655), cholangitis (2.5%; 95% CI, 1.9%–3.3%; I², 96%; n = 121,619), cholecystitis (0.8%; 95% CI, 0.5%–1.2%; I², 39%; n = 7799), and perforation (0.5%; 95% CI, 0.4%–0.6%; I², 90%; n = 306,378). Conclusions: ERCP-associated AEs remain common. Incidence of post-ERCP pancreatitis remained static despite improvements in techniques, prevention, and recognition. These results are important to patients, endoscopists, and policy makers to inform consent and to encourage implementation of available risk mitigation strategies.

Original language	English (US)
Pages (from-to)	568-586
Number of pages	19
Journal	Gastroenterology
Volume	168
Issue number	3
DOIs	https://doi.org/10.1053/j.gastro.2024.10.033
State	Published - Mar 2025

Funding

Kirles Bishay, MD, MSc (Investigation: Supporting; Supervision: Supporting; Writing \u2013 original draft: Lead; Writing \u2013 review & editing: Supporting), Zhao Wu Meng, MD, MSc (Investigation: Supporting; Supervision: Supporting; Writing \u2013 original draft: Lead; Writing \u2013 review & editing: Supporting), Rishad Khan, MD (Writing \u2013 original draft: Supporting; Writing \u2013 review & editing: Supporting), Mehul Gupta, MD (Formal analysis: Equal; Writing \u2013 original draft: Supporting; Writing \u2013 review & editing: Supporting), Yibing Ruan, PhD, MPH (Formal analysis: Equal; Writing \u2013 original draft: Supporting; Writing \u2013 review & editing: Supporting), Marcus Vaska, MLIS (Investigation: Supporting; Writing \u2013 review & editing: Supporting), Jordan Iannuzzi, MD (Investigation: Supporting; Writing \u2013 review & editing: Supporting), Dylan E. O'Sullivan, PhD (Investigation: Supporting; Writing \u2013 review & editing: Supporting), Brittany Mah, BSc (Investigation: Supporting; Writing \u2013 review & editing: Supporting), Amanda M. Henderson, MD (Investigation: Supporting; Writing \u2013 review & editing: Supporting), Arun C.R. Partridge, MD (Investigation: Supporting; Writing \u2013 review & editing: Supporting), Howard Guo, MD (Investigation: Supporting; Writing \u2013 review & editing: Supporting), Sunil Samnani, MD (Investigation: Supporting; Writing \u2013 review & editing: Supporting), Max DeMarco, BSc (Investigation: Supporting; Writing \u2013 review & editing: Supporting), Yuhong Yuan, PhD (Methodology: Supporting; Writing \u2013 review & editing: Supporting), B. Joseph Elmunzer, MD, MSc (Investigation: Supporting; Writing \u2013 review & editing: Supporting), Rajesh N. Keswani, MD, MSc (Investigation: Supporting; Writing \u2013 review & editing: Supporting), Sachin Wani, MD (Investigation: Supporting; Writing \u2013 review & editing: Supporting), Zachary L. Smith, DO (Investigation: Supporting; Writing \u2013 review & editing: Supporting), Ronald J. Bridges, MD (Investigation: Supporting; Writing \u2013 review & editing: Supporting), Steven J. Heitman, MD, MSc (Investigation: Supporting; Writing \u2013 review & editing: Supporting), Robert J. Hilsden, MD, PhD (Investigation: Supporting; Writing \u2013 review & editing: Supporting), Darren R. Brenner, PhD (Investigation: Supporting; Supervision: Supporting; Writing \u2013 review & editing: Supporting), Grigorios I. Leontiadis, MD, PhD (Investigation: Supporting; Supervision: Supporting; Writing \u2013 review & editing: Supporting), Nauzer Forbes, MD MSc (Conceptualization: Lead; Investigation: Lead; Supervision: Lead; Writing \u2013 original draft: Supporting; Writing \u2013 review & editing: Lead)

Keywords

Adverse Event
Bleeding
Complication
ERCP
Pancreatitis
Quality

ASJC Scopus subject areas

Hepatology
Gastroenterology

Access to Document

10.1053/j.gastro.2024.10.033

Cite this

Bishay, K., Meng, Z. W., Khan, R., Gupta, M., Ruan, Y., Vaska, M., Iannuzzi, J., O'Sullivan, D. E., Mah, B., Partridge, A. C. R., Henderson, A. M., Guo, H., Samnani, S., DeMarco, M., Yuan, Y., Elmunzer, B. J., Keswani, R. N., Wani, S., Smith, Z. L., ... Forbes, N. (2025). Adverse Events Associated With Endoscopic Retrograde Cholangiopancreatography: Systematic Review and Meta-Analysis. Gastroenterology, 168(3), 568-586. https://doi.org/10.1053/j.gastro.2024.10.033

@article{31771a9cdfaa41c1a9a2f0320c4510a0,

title = "Adverse Events Associated With Endoscopic Retrograde Cholangiopancreatography: Systematic Review and Meta-Analysis",

abstract = "Background & Aims: Endoscopic retrograde cholangiopancreatography (ERCP)–related adverse events (AEs) are associated with morbidity, mortality, and health care expenditure. We aimed to assess incidences and comparisons of ERCP AEs. Methods: We included studies performed after 2000 reporting on ERCP AEs from database inception through March 12, 2024. Outcomes included pancreatitis, bleeding, cholangitis, cholecystitis, perforation, and death. DerSimonian and Laird random effects meta-analyses were performed to calculate incidences of AEs. Subgroup and pairwise meta-analyses were performed. Meta-regression was performed on median recruitment year to assess temporal trends in pancreatitis incidence. Results: A total of 380 studies were included. The incidence of death attributable to ERCP was 0.2% (95% confidence interval [CI], 0.1%–0.3%; I2, 44%; n = 47,258) in all-comers. The overall incidence of pancreatitis was 4.6% (95% CI, 4.0%–5.1%; I2, 96%; n = 293,378) among all-comers and 6.5% (95% CI, 5.9%–7.1%, I2, 89%; n = 88,809) among first-time patients. Pancreatitis incidence remained stable between 2000 and 2023 (average annual percent change 0.06, 95% CI, −0.27 to 0.39). The overall incidences of the following AEs for all-comers were: bleeding (1.5%; 95% CI, 1.2%–1.7%; I2, 93%; n = 229,655), cholangitis (2.5%; 95% CI, 1.9%–3.3%; I2, 96%; n = 121,619), cholecystitis (0.8%; 95% CI, 0.5%–1.2%; I2, 39%; n = 7799), and perforation (0.5%; 95% CI, 0.4%–0.6%; I2, 90%; n = 306,378). Conclusions: ERCP-associated AEs remain common. Incidence of post-ERCP pancreatitis remained static despite improvements in techniques, prevention, and recognition. These results are important to patients, endoscopists, and policy makers to inform consent and to encourage implementation of available risk mitigation strategies.",

keywords = "Adverse Event, Bleeding, Complication, ERCP, Pancreatitis, Quality",

author = "Kirles Bishay and Meng, {Zhao Wu} and Rishad Khan and Mehul Gupta and Yibing Ruan and Marcus Vaska and Jordan Iannuzzi and O'Sullivan, {Dylan E.} and Brittany Mah and Partridge, {Arun C.R.} and Henderson, {Amanda M.} and Howard Guo and Sunil Samnani and Max DeMarco and Yuhong Yuan and Elmunzer, {B. Joseph} and Keswani, {Rajesh N.} and Sachin Wani and Smith, {Zachary L.} and Bridges, {Ronald J.} and Heitman, {Steven J.} and Hilsden, {Robert J.} and Brenner, {Darren R.} and Leontiadis, {Grigorios I.} and Nauzer Forbes",

note = "Publisher Copyright: {\textcopyright} 2025 The Authors",

year = "2025",

month = mar,

doi = "10.1053/j.gastro.2024.10.033",

language = "English (US)",

volume = "168",

pages = "568--586",

journal = "Gastroenterology",

issn = "0016-5085",

publisher = "W.B. Saunders",

number = "3",

}

Bishay, K, Meng, ZW, Khan, R, Gupta, M, Ruan, Y, Vaska, M, Iannuzzi, J, O'Sullivan, DE, Mah, B, Partridge, ACR, Henderson, AM, Guo, H, Samnani, S, DeMarco, M, Yuan, Y, Elmunzer, BJ, Keswani, RN, Wani, S, Smith, ZL, Bridges, RJ, Heitman, SJ, Hilsden, RJ, Brenner, DR, Leontiadis, GI & Forbes, N 2025, 'Adverse Events Associated With Endoscopic Retrograde Cholangiopancreatography: Systematic Review and Meta-Analysis', Gastroenterology, vol. 168, no. 3, pp. 568-586. https://doi.org/10.1053/j.gastro.2024.10.033

TY - JOUR

T1 - Adverse Events Associated With Endoscopic Retrograde Cholangiopancreatography

T2 - Systematic Review and Meta-Analysis

AU - Bishay, Kirles

AU - Meng, Zhao Wu

AU - Khan, Rishad

AU - Gupta, Mehul

AU - Ruan, Yibing

AU - Vaska, Marcus

AU - Iannuzzi, Jordan

AU - O'Sullivan, Dylan E.

AU - Mah, Brittany

AU - Partridge, Arun C.R.

AU - Henderson, Amanda M.

AU - Guo, Howard

AU - Samnani, Sunil

AU - DeMarco, Max

AU - Yuan, Yuhong

AU - Elmunzer, B. Joseph

AU - Keswani, Rajesh N.

AU - Wani, Sachin

AU - Smith, Zachary L.

AU - Bridges, Ronald J.

AU - Heitman, Steven J.

AU - Hilsden, Robert J.

AU - Brenner, Darren R.

AU - Leontiadis, Grigorios I.

AU - Forbes, Nauzer

PY - 2025/3

Y1 - 2025/3

N2 - Background & Aims: Endoscopic retrograde cholangiopancreatography (ERCP)–related adverse events (AEs) are associated with morbidity, mortality, and health care expenditure. We aimed to assess incidences and comparisons of ERCP AEs. Methods: We included studies performed after 2000 reporting on ERCP AEs from database inception through March 12, 2024. Outcomes included pancreatitis, bleeding, cholangitis, cholecystitis, perforation, and death. DerSimonian and Laird random effects meta-analyses were performed to calculate incidences of AEs. Subgroup and pairwise meta-analyses were performed. Meta-regression was performed on median recruitment year to assess temporal trends in pancreatitis incidence. Results: A total of 380 studies were included. The incidence of death attributable to ERCP was 0.2% (95% confidence interval [CI], 0.1%–0.3%; I2, 44%; n = 47,258) in all-comers. The overall incidence of pancreatitis was 4.6% (95% CI, 4.0%–5.1%; I2, 96%; n = 293,378) among all-comers and 6.5% (95% CI, 5.9%–7.1%, I2, 89%; n = 88,809) among first-time patients. Pancreatitis incidence remained stable between 2000 and 2023 (average annual percent change 0.06, 95% CI, −0.27 to 0.39). The overall incidences of the following AEs for all-comers were: bleeding (1.5%; 95% CI, 1.2%–1.7%; I2, 93%; n = 229,655), cholangitis (2.5%; 95% CI, 1.9%–3.3%; I2, 96%; n = 121,619), cholecystitis (0.8%; 95% CI, 0.5%–1.2%; I2, 39%; n = 7799), and perforation (0.5%; 95% CI, 0.4%–0.6%; I2, 90%; n = 306,378). Conclusions: ERCP-associated AEs remain common. Incidence of post-ERCP pancreatitis remained static despite improvements in techniques, prevention, and recognition. These results are important to patients, endoscopists, and policy makers to inform consent and to encourage implementation of available risk mitigation strategies.

AB - Background & Aims: Endoscopic retrograde cholangiopancreatography (ERCP)–related adverse events (AEs) are associated with morbidity, mortality, and health care expenditure. We aimed to assess incidences and comparisons of ERCP AEs. Methods: We included studies performed after 2000 reporting on ERCP AEs from database inception through March 12, 2024. Outcomes included pancreatitis, bleeding, cholangitis, cholecystitis, perforation, and death. DerSimonian and Laird random effects meta-analyses were performed to calculate incidences of AEs. Subgroup and pairwise meta-analyses were performed. Meta-regression was performed on median recruitment year to assess temporal trends in pancreatitis incidence. Results: A total of 380 studies were included. The incidence of death attributable to ERCP was 0.2% (95% confidence interval [CI], 0.1%–0.3%; I2, 44%; n = 47,258) in all-comers. The overall incidence of pancreatitis was 4.6% (95% CI, 4.0%–5.1%; I2, 96%; n = 293,378) among all-comers and 6.5% (95% CI, 5.9%–7.1%, I2, 89%; n = 88,809) among first-time patients. Pancreatitis incidence remained stable between 2000 and 2023 (average annual percent change 0.06, 95% CI, −0.27 to 0.39). The overall incidences of the following AEs for all-comers were: bleeding (1.5%; 95% CI, 1.2%–1.7%; I2, 93%; n = 229,655), cholangitis (2.5%; 95% CI, 1.9%–3.3%; I2, 96%; n = 121,619), cholecystitis (0.8%; 95% CI, 0.5%–1.2%; I2, 39%; n = 7799), and perforation (0.5%; 95% CI, 0.4%–0.6%; I2, 90%; n = 306,378). Conclusions: ERCP-associated AEs remain common. Incidence of post-ERCP pancreatitis remained static despite improvements in techniques, prevention, and recognition. These results are important to patients, endoscopists, and policy makers to inform consent and to encourage implementation of available risk mitigation strategies.

KW - Adverse Event

KW - Bleeding

KW - Complication

KW - ERCP

KW - Pancreatitis

KW - Quality

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DO - 10.1053/j.gastro.2024.10.033

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SN - 0016-5085

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Adverse Events Associated With Endoscopic Retrograde Cholangiopancreatography: Systematic Review and Meta-Analysis

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