Complications of endoscopic sphinecterotomy and their treatment.

Despite the careful observance of standard precautions during endoscopic sphincterotomy, serious complications are sometimes unavoidable and these may require various forms of treatment. Surgical intervention is necessary for fulminating pancreatitis, acute arterial hemorrhage, and retroperitoneal abscess. The endoscopic insertion of a drainage tube into the common bile duct can serve to overcome biliary obstruction due to cholangitis secondary to stone impaction, Dormia basket impaction or blood clot. The obstruction can be removed electively either endoscopically or surgically in a symptom-free interval. Uncomplicated perforation can be treated by parenteral feeding and naso-gastric suction. Acute pancreatitis may require further intensive care procedures such as peritoneal or hemodialysis and early intermittent positive pressure respiration. By using these means the mortality rate due to ES is reduced to 0.5%.