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Grading system for the major complications of endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy

Grading system for the major complications of endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy
  Mild Moderate Severe
Pancreatitis Amylase at least three times normal at more than 24 hours after the procedure, requiring admission or prolongation of planned admission to two to three days Hospitalization of 4 to 10 days Hospitalization of more than ten days, hemorrhagic pancreatitis, phlegmon or pseudocyst, or intervention (percutaneous drainage or surgery)
Bleeding Clinical (not just endoscopic) evidence of bleeding, hemoglobin drop <3 g, and no need for transfusion Transfusion (four units or less), no angiographic intervention or surgery Transfusion (five units or more) or intervention (angiographic or surgical)
Cholangitis Temperature of >38°C for 24 to 48 hours Febrile or septic illness requiring more than three days of hospital treatment or endoscopic or percutaneous intervention Septic shock or surgery
Perforation Possible, or only very slight leak of fluid or contrast, treatable by fluids and suction for three days or less Any definite perforation treated medically for 4 to 10 days Medical treatment for more than 10 days, or intervention (percutaneous or surgical)
Adapted with permission from: Cotton PB, et al. Endoscopic sphincterotomy complications and their management: An attempt at consensus. Gastrointest Endosc 1991; 37:383.
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