The ASGE ERCP (Endoscopic retrograde cholangiopancreatography) grading scale indicates the procedure complexity and predicts the chance of complictions.
The ERCP grading scale:
Grade 1
-Deep cannulation of duct of interest, main papilla, sampling
-Biliary stent removal/exchange
Grade 2
Biliary stone extraction < 10 mm
Treat biliary leaks
Treat extrahepatic benign and malignant strictures
-Place prophylactic pancreatic stents
Grade 3
-Biliary stone extraction > 10 mm
-Minor papilla cannulation in divisum, and therapy
-Removal of internally migrated biliary stents
-Intraductal imaging, biopsy, FNA
-Management of acute or recurrent pancreatitis
-Treat pancreatic strictures
-Remove pancreatic stones mobile and < 5 mm
-Treat hilar tumors
-Treat benign biliary strictures, hilum, and above
-Manage suspected sphincter of Oddi dysfunction (with or without manometry)
Grade 4
-Remove internally migrated pancreatic stents
-Intraductal image-guided therapy
-Pancreatic stones impacted and/or > 5 mm
-Intrahepatic stones
-Pseudocyst drainage, necrosectomy
-Papillectomy
-ERCP after Whipple or Roux-en-Y bariatric surgery
Increase 1 level (to a maximum of 4) when the patient has had Billroth II gastrectomy
ERCP adverse event rates

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