Parasites and Biliary stones

Endoscopic retrograde cholangiopancreatography ١٣٤
Recent studies have shown that if the gallbladder is left intact after
sphincterotomy, both early and late cholecystitis occur more frequently
than previously thought. Both cholecystitis and recurrent bile duct stones
are more common if the gallbladder that is left in-situ contains stones
(Hill et al., 1991).
Possible mechanisms of ERCP induced cholecystitis include
contamination of the gallbladder by instillation of contrast media, or
duodeno-biliary reflux and bacterobilia (Freeman, 2002). There are no
clear means for preventing post-ERCP cholecystitis other than
cholecystectomy (Boerma et al., 2002).
5- Complications secondary to endoscopy:
Other complications of ERCP are those related to endoscopy and
include esophageal, liver, and splenic injury. Seventy-five percent of
esophageal perforations in adults occur during endoscopy . The most
common sites are the distal esophagus and adjacent to the
cricopharyngeus. At CT, pneumomediastinum, mediastinitis, and
extravasation of contrast material can be seen. Pleural effusion and
pneumothorax can also develop within 12–24 hours (Stewart et al.,
1994). Surgery is usually needed for repair.Laceration of the liver or
spleen can result from direct or indirect trauma as the endoscope is passed
through the stomach and duodenum (Lewis et al., 1991 and Wu and
Katon, 1993).
6- Stent migration:
Migration of a common bile duct or pancreatic duct stent occurs in
up to 5.9% of cases. Migration can occur into the proximal duct or into
the gut. Risk factors associated with proximal stent migration are
malignant strictures, large stent diameter, and short stent length. Distally