Rare and underappreciated complications of endoscopic retrograde cholangiopancreatography

Endoscopic retrograde cholangiopancreatography has evolved to a largely therapeutic procedure for the management of a variety of benign and malignant disorders of the pancreas and biliary tree. Although the most commonly implicated adverse events include pancreatitis, postsphincterotomy hemorrhage and perforation, cardiopulmonary issues (such as aspiration), and infection, there are a multitude of rare and often underappreciated complications that may occur. These are often related to endoscope manipulation, air insufflation, endoscopic retrograde cholangiopancreatography devices, and iodinated contrast. This article provides an abridged review of these events, with some anecdotal observations of how these may be prevented and addressed.