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Acute pancreatitis, bleeding, perforation, and cholangitis are the main AEs associated with ERCP. Acute pancreatitis is the most frequent AE and can become severe and even fatal. Diagnostic EUS is relatively safe, although events such as pancreatitis, bleeding, infection, and needle tract seeding via the puncture site have been reported with EUS\u2010guided tissue acquisition. In addition, therapeutic EUS has specific AEs, including peritonitis due to leakage of bile or pancreatic fluid, stent migration, and bleeding. Risk management in pancreatobiliary endoscopy requires a multifaceted approach, including sedation strategies appropriate to the patient's background and procedural difficulty, antithrombotic management, and preventive measures for and early response to procedure\u2010specific AEs. In recent years, safety has steadily improved with the establishment of post\u2010ERCP pancreatitis preventive measures such as rectal nonsteroidal anti\u2010inflammatory drugs administration and pancreatic duct stent placement. In therapeutic EUS, recent advances include the development of metal stents with thin\u2010diameter delivery systems and lumen\u2010apposing metal stents, as well as technical refinements in stent deployment. This review summarizes the latest evidence and guidelines regarding anesthesia management, AEs, prevention strategies, and management approaches related to ERCP and diagnostic and therapeutic EUS. Systematic risk assessment and standardized techniques are key to ensuring safe, high\u2010quality endoscopic pancreatobiliary care.<\/jats:p>","DOI":"10.1111\/den.70288","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T14:28:41Z","timestamp":1789482521000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Risk Management in\n                    <scp>ERCP<\/scp>\n                    and Endoscopic Ultrasound"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5611-2509","authenticated-orcid":false,"given":"Takashi","family":"Tamura","sequence":"first","affiliation":[{"name":"Second Department of Internal Medicine Wakayama Medical University  Wakayama City Wakayama 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