Massive Hemobilia due to Hepatic Arteriobiliary Fistula during Endoscopic Retrograde Cholangiopancreatography: An Extremely Rare Guidewire-Related Complication

Endoscopic retrograde cholangiopancreatography (ERCP) is commonly performed to diagnose and treat hepato-pancreatobiliary diseases. But it has a higher potential for procedure-related complications compared to other endoscopic procedures in the upper gastrointestinal tract (1). Even in the best hands, serious complications from therapeutic ERCP occur in 2.5–8% of cases, with mortality ranging from 0.5–1.1% (2). Guidewire cannulation is widely used for bile duct cannulation during ERCP. Although complications of ERCP due to guidewire-related injury are rare and can be managed conservatively, they can be life-threatening (3). We report on a case of massive hemobilia due to hepatic arteriobiliary fistula caused by guidewire-associated injury during ERCP that was successfully treated with hepatic arterial embolization. To the best of our knowledge, this is the first report of a hepatic arteriobiliary fistula caused by guidewire-associated injury during ERCP.