title: Management of post-ERCP complications.
abstract: Endoscopic retrograde cholangiopancreatography (ERCP) has the highest risk of complication of any endoscopic procedure routinely performed by gastroenterologists or surgeons. Adverse events are inevitable when performing ERCP, and one must learn to manage these appropriately when they occur. One avenue for a successful outcome after a complication of ERCP is to follow the "5R model" of management: recognize, react, reach out, repent, and revisit. Several case studies are used as examples of intervention after complication, especially after retroperitoneal perforation. The literature is briefly reviewed in some areas, and I draw upon my own experience extensively in others. If there is a sixth R in the model it would be to "rejoice" when a patient is successfully managed and is finally sent home in good health.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Baystate Medical Center, University of Massachusetts Medical School, Springfield, MA, USA - David.Desilets@baystatehealth.org.
authors.forename: David J
authors.initials: DJ
authors.lastname: Desilets
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D019468:Disease Management; D004322:Drainage / Q000295:instrumentation; D042241:Early Diagnosis; D004646:Emphysema / Q000209:etiology / Q000628:therapy; D005260:Female; D006801:Humans; D007327:Insufflation / Q000009:adverse effects; D007431:Intraoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology / Q000628:therapy; D010349:Patient Compliance; D010537:Peritoneum / Q000293:injuries; D010817:Physician-Patient Relations; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000628:therapy; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000628:therapy; D012017:Referral and Consultation; D012187:Retroperitoneal Space; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects* / Q000379:methods; D015607:Stents