The risk of variceal bleeding during endoscopic retrograde cholangiopancreatography - Abstract and study findings

Sep 29, 2026

Endoscopic retrograde cholangiopancreatography (ERCP) is widely used, yet the danger of variceal bleeding has rarely been quantified. This retrospective study evaluated the 30-day risk of gastrointestinal and variceal bleeding and other procedure-related adverse events in cirrhotic patients undergoing elective ERCP. Of 75 enrolled patients, 45 had esophageal varices (EV). No esophageal variceal bleeding occurred; one gastric variceal bleed occurred after ERCP. Nonvariceal bleeding and post-ERCP pancreatitis were not higher in patients with EV.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages5

Reading Time13 min

AccessFree to download

Introduction

Methods

Patients

Endoscopic evaluation

J Chin MedAssoc Original article The risk of variceal bleeding during endoscopic retrograde cholangiopancreatography Hsiao-Sheng Lua,b,c, Tsung-Chieh Yangb,d, Chung-Yu Changb,d, Yi-Hsiang Huangb,d, Ming-Chih Houb,c,d,* aDepartment of Medicine, Taipei Veterans General Hospital, Yuan-Shan Branch, Yilan, Taiwan, ROC; bDivision of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; cEndoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; dFaculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC Abstract Background: Endoscopic retrograde cholangiopancreatography (ERCP) is a widely performed procedure. However, the risk of variceal bleeding during ERCP has rarely been assessed. This study aims to evaluate the risk of variceal bleeding in patients with esophageal varices (EV) undergoing ERCP. Methods: From October 2010 to November 2017, the study retrospectively enrolled 75 cirrhotic patients who received elective ERCP. The patient’s risk of gastrointestinal (GI) and variceal bleeding and other procedure-related adverse events within 30 days of ERCP were evaluated. Results: Among the 75 patients, 45 patients (60 .0%) had EV. Most of the patients were males (65 .3%), and there were high rates of viral hepatitis B-related cirrhosis (36 .0%), Child-Pugh B (49 .3%), and an indication of choledocholithiasis (40 .0%) . Thirty-three of 45 (73 .3%) patients had high-risk EV, and nine (20 .0%) patients had concomitant gastric varices. There was no esophageal variceal bleeding; however, one patient had gastric variceal bleeding after ERCP. Nonvariceal significant GI bleeding occurred in three patients with EV and one without EV (p = 0 .529) . Post-ERCP pancreatitis occurred in three patients with EV and five without EV (p = 0. 169) . No perforation or procedure-associated mortality was noted. Conclusion: The risk of esophageal variceal bleeding within 30 days of ERCP is neglectable, except for a patient who suffered from gastric variceal bleeding. Other complications, such as nonvariceal bleeding and pancreatitis, are also no higher in patients with EV. Therefore, ERCP is generally a safe procedure for a patient with high-risk esophageal varices. Keywords: Endoscopic retrograde cholangiopancreatography; Esophageal varices; Gastric varices; Variceal bleeding 1. INTRODUCTION Endoscopic retrograde cholangiopancreatography (ERCP) has been a reliable and widely accepted procedure for pancreaticobiliary disease since it was first reported in 1968.1 However, ERCP continues to be associated with several adverse events, which are attributed to the procedural invasiveness.2,3 Due to the blind insertion of duodenoscope and coagulation abnormality as well as thrombocytopenia in patients with liver cirrhosis, variceal bleeding precipitated by ERCP is a major concern, but there is no robust evidence to highlight the risk. Esophageal variceal bleeding was one of the major complications of liver cirrhosis and had a 6-week mortality rate between *Address correspondence. Dr. Ming-Chih Hou, Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, ROC. E-mail address: mchou@ [vghtpe.gov.tw](vghtpe.gov.tw) (M.-C. Hou). Conflicts of interest: Dr. Yi-Hsiang Huang and Dr. Ming-Chih Hou, editorial board members at Journal of the Chinese Medical Association, have no roles in the peer review process of or decision to publish this article. The other authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article. Journal of Chinese Medical Association. (2022) 85: 896-900. Received September 7, 2021; accepted June 16, 2022. doi: 10. 1097/JCMA.0000000000000773. Copyright © 2022, the Chinese Medical Association. This is an open access

FAQs

What was the primary aim of the study about ERCP?

To evaluate the 30-day risk of variceal bleeding in cirrhotic patients with esophageal varices undergoing ERCP, along with other procedure-related adverse events.

Were any esophageal variceal bleeding events observed after ERCP?

No esophageal variceal bleeding was observed among the 75 patients in the 30-day follow-up.

What complications occurred after ERCP besides variceal bleeding?

Nonvariceal significant gastrointestinal bleeding occurred in a few patients, and post-ERCP pancreatitis occurred in both EV and non-EV groups; no perforation or procedure-associated mortality was noted.

Sep 29, 2026

Uploaded by Riley West