Management of Duodenal Perforation After Endoscopic Retrograde Cholangiopancreatography and Sphincterotomy

Yoo

Journal of Gastrointestinal Surgery

et al. 2009

Introduction The aim of this study was to analyze clinicoradiologic findings and treatment outcomes of patients with endoscopic retrograde cholangiopancreatography (ERCP)-related perforations. Between May 2003 and November 2007, 2,247 ERCP procedures with or without sphincterotomy were performed at Ajou University Medical Center, Suwon, Korea, and 20 perforations (0.89%) were identified. Discussion We retrospectively reviewed medical and surgical records of each patient. Of 18 patients, 11 patients (61.1%) underwent nonsurgical management, and seven patients (38.9%) received surgical management. There were no significant differences in age, gender, and laboratory findings between two groups (P>0.05). The hospital stay was significantly longer in the operative group than that of the conservative group (P<0.05, respectively). The most common cause of perforation was sphincterotomy (n=8) in the conservative group whereas scope itself (n=6) in operative group, showing a significant difference between the two groups (P<0.05). The retroperitoneal air was most common findings in eight patients (72.7%) of the conservative group, while six (85.7%) patients of the operative group presented with intraperitoneal air, displaying a significant difference in location of air between the two groups (P<0.05). Most of sphincterotomy-related perforations were managed nonsurgically. However, the scope-related perforations were usually large and required immediate surgery. Moreover, the delayed operation resulted in a longer hospital stay and high morbidity. Therefore, the selective early surgical intervention is suggested when scope-related perforations are discovered.

Section: Introductionmentioning

confidence: 99%

Management of ERCP-Related Perforations: Outcomes of Single Institution in Korea

Yoo

Journal of Gastrointestinal Surgery

et al. 2009

“…Although emergency surgical treatment has been advocated in previous studies, conservative treatment was commonly reported with successful outcomes in appropriate cases in recent series. (10,12,18,19). Mortality rates between 7% and 25% were reported in several studies, in which the most common types of perforations were type I and II (12,19,20).…”

Section: Discussionmentioning

confidence: 98%

“…Various classification methods have been presented for the definition and classification of ERCP-related perforations (10,11). In this study, we used the classification system that Stapfer et al (10) previously introduced.…”

Section: Discussionmentioning

confidence: 99%

“…This highly invasive procedure is associated with a higher frequency of serious complications, ranging between 4% and 16% (3)(4)(5)(6)(7). Although the risk of ERCP-related perforation (ERCP-rP) is low (<1% for patients undergoing sphincterotomy), it is associated with high morbidity and mortality, particularly for patients in whom conservative therapy is unsuccessful and who have a delayed diagnosis of perforation (8)(9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

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Management of iatrogenic injuries due to endoscopic sphincterotomy: Surgical or conservative approaches

Bostancı¹,

Battal²,

Yazici³

et al. 2018

Turk J Surg

Based on a single center experience with the management of ERCP-rP, we aimed to analyze the types of injuries, surgical options, and outcomes of patients with ERCP-rP. MATERIAL AND METHODSOver a five-year period between January 2010 and October 2015, all ERCP procedures (n=3432) that were performed at the Gastroenterology and General Surgery Clinic at Şişli Hamidiye Etfal Training and Research Objective: The best therapeutic approach for endoscopic retrograde cholangiopancreatography-related perforations remains controversial; while some authors suggest routine conservative management, others advocate mandatory surgical exploration. We aimed to evaluate our clinical experience of perforations during endoscopic sphincterotomy. Material and Methods:A retrospective chart review from January 2010 to October 2015 identified 20 patients with endoscopic retrograde cholangiopancreatography-related perforations. Data collection included demographics, time to diagnosis, type of perforation, treatment strategy, surgical procedure, complications, hospital stay, and outcome. All patients were classified into two groups on the basis of radiological and operative findings. Results:Only five patients underwent surgical treatment, whereas 15 patients were managed conservatively. The mean time to diagnosis was 7.8 hrs (range: 1 to 36 hrs). In patients who underwent surgical treatment, the types of perforations included type I and III in one patient each and type II in three patients. Surgical procedures included laparoscopic and open cholecystectomy with t-tube drainage in two patients each and primary repair of duodenal injury with hepaticojejunostomy in one patient. Among conservatively managed patients, eight, four, and three had type II, type III, and type IV injuries, respectively. Of these 15 patients, 60% (n=9) underwent percutaneous procedures. The mean length of hospital stay was similar for conservatively and surgically treated patients (12 vs. 12.4 days, respectively, p=0.790). One patient (5%) with type I injury died of multiorgan deficiency. Conclusion:With close close clinical follow-up, medical treatment can be beneficial for most patients, and surgical procedures should be reserved for patients with type I (definite) and type II/III injuries; in patients with these clinical parameters, conservative management will likely be unsuccessful.

Best Practice & Research Clinical Gastroenterology

“…The most commonly used classification of ERCP-induced perforation was suggested by Stapfer et al according to that, perforations can be categorized into four types. Bowel perforation is more frequent in patients with Billroth II gastrectomy or Roux-en-Y operation, duodenal stricture, parapapillar diverticulum, while sphincterotomy perforation is more common during needle knife precut [25,73]. It can be prevented by ensuring the correct orientation of the cutting wire during sphincterectomy, following a step-by-step incision, tailoring the size of the papilla and bile ducts, and using balloon dilation of the papilla after a small sphincterotomy in cases of large stones [5].…”

Section: Endoscopic Retrograde Cholangiopancreatography (Ercp)mentioning

confidence: 99%

Emergencies after endoscopic procedures

Rolanda

Caetano

Dinis-Ribeiro

2013

Keywords:GI endoscopy adverse events GI emergencies Bleeding Haemorrhage Perforation Infection Embolization Diagnosis and management of severe complications a b s t r a c t Endoscopy adverse events (AEs), or complications, are a rising concern on the quality of endoscopic care, given the technical advances and the crescent complexity of therapeutic procedures, over the entire gastrointestinal and bilio-pancreatic tract. In a small percentage, not established, there can be real emergency conditions, as perforation, severe bleeding, embolization or infection. Distinct variables interfere in its occurrence, although, the awareness of the operator for their potential, early recognition, and local organized facilities for immediate handling, makes all the difference in the subsequent outcome. This review outlines general AEs' frequencies, important predisposing factors and putative prophylactic measures for specific procedures (from conventional endoscopy to endoscopic cholangio-pancreatography and ultrasonography), with comprehensive approaches to the management of emergent bleeding and perforation.