Management of endoscopic retrograde cholangiopancreatography: related duodenal perforations

Avgerinos, Dimitrios V.; Llaguna, Omar H.; Lo, Andrew Y.; Voli, Joseph; Leitman, I. Michael

doi:10.1007/s00464-008-0157-9

Cited by 95 publications

(83 citation statements)

References 13 publications

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“…In this respect, persistence with conservative treatment in the absence of signs of improvement should be avoided as the mortality rate increases dramatically with delayed surgical intervention. 8,9 In Patient 4, the florid abdominal signs, in addition to the presence of fever and leucocytosis, militated against conservative treatment. Nevertheless, careful interpretation of the ERCP and CT, revealed a rarely reported guidewire injury of the pancreatic duct, resulting in peripancreatic air collection (Figs 5 and 6), which was assumed to respond well to conservative treatment.…”

Section: Operative Interventionsmentioning

confidence: 99%

Operative and non-operative management of endoscopic retrograde cholangiopancreatography-associated duodenal injuries

Rabie

Mir

Skaini

et al. 2013

annals

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INTRODUCTION Endoscopic retrograde cholangiopancreatography (ERCP) is indispensable in everyday surgical practice.Despite this, as an invasive procedure, it has its own mortality and morbidity, the most feared of which is periduodenal perforations. Our experience with ERCP related periduodenal perforations and its treatment strategies are presented. Additionally, a rarely encountered subtype is highlighted. METHODS Patients who underwent ERCP and sustained a periduodenal perforation between August 2008 and October 2011 were reviewed. RESULTS During the period from August 2008 to October 2011, 597 ERCP procedures were performed in our hospital. Ten of these patients (3 male, 7 female) had a perforation. The mean patient age was 56.6 years. During the procedure, injury was suspected in four patients; it passed unnoticed in the remaining six. The decision to operate or follow a conservative policy was based on a combination of clinical and radiological findings. Operative intervention was required in three patients, with one mortality, while conservative treatment was followed in the remaining seven. A laparotomy was performed early in two patients whereas it was performed after an initial period of conservative treatment in one. The presence of periduodenal fluid collection, contrast extravasation or free intraperitoneal air were decisive factors for performing laparotomy. CONCLUSIONS ERCP-related periduodenal perforations include different categories. Certain types require operative repair while others should be treated conservatively. The choice of the management approach should be individualised, depending on the clinical picture and radiological findings. Although rare, these are potentially serious complications that may end fatally. Early recognition and appropriate intervention is the only way to avert a fatal outcome.

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Section: Operative Interventionsmentioning

confidence: 99%

Operative and non-operative management of endoscopic retrograde cholangiopancreatography-associated duodenal injuries

Rabie

Mir

Skaini

et al. 2013

annals

View full text Add to dashboard Cite

show abstract

“…14 Free air in an otherwise asymptomatic patient can be categorized as type IV injury and needs no surgical intervention, though the patient may require close monitoring to ensure peritoneal signs do not develop; 6,15 this type of injury was most common in our series.…”

Section: Discussionmentioning

confidence: 85%

“…1 While relatively safe, ERCP is still associated with complications, most commonly pancreatitis, post-sphincterotomy bleeding and perforation. 2,3 Perforations are one of the most dreaded complications of ERCP, with a reported incidence of 0.3-6%; [3][4][5][6][7] however, this data has come from retrospective database studies, case series or older studies. Studies from large prospective databases or from large tertiary centers in the current era of therapeutic ERCP are few.…”

Section: Introductionmentioning

confidence: 99%

ERCP‐related perforations in the new millennium: A large tertiary referral center 10‐year experience

et al. 2015

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Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) is an important diagnostic and therapeutic modality for pancreatic and biliary disorders. Perforation is one of the most dreaded complications of ERCP. Since it is uncommon, there has been little study of incidence, risk factors, and outcomes of management. Objectives: We aim to assess the incidence of ERCP-related perforations and outcomes at a large tertiary referral center. Methods: We undertook a review of an ERCP database for all perforations from 2002 to December 2012. Results: The cumulative incidence of ERCP-related perforations was 0.14% (12 out of 8264), and sphincterotomy-related perforations constituted the most common cause. The mean age of these 12 patients was 58.6 years and majority were female (83.3%). The most common indications for ERCP were: suspected sphincter of Oddi dysfunction (SOD) 41%, and common bile duct stones (CBD stones) 41%. Nine of the 12 patients (75%) had a leak and were managed medically, and four who had a perforation had surgical repair (25%). Conclusions: In our study, leaks were much more common than perforations and the majority of patients were successfully managed with conservative therapy alone. We report a very low perforation rate and most perforations can be managed conservatively with a good outcome.

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“…However, in the past decade the management has evolved towards a selective approach. [3][4][5][6][7][8] ERCP induced perforation (major complications 5.4%-23.0%, mortality 0.1-1%) [14][15][16][17] may be retroperitoneal (typically in peri-ampullary region due to sphincterotomy or guidewire usage) or intra-peritoneal (typically in the lateral wall and endoscopy related). 1,2,7,9,12,[14][15][16][17] Depending on the perforation location the treatment can be conservative or operative.…”

Section: Introductionmentioning

confidence: 99%

“…Delay in the diagnosis and intervention, leads to significantly higher mortality (8-23%) as a consequence of sepsis and multi-organ failure. [1][2][3][4][5][6][7][8][9][10][11][12][13] Traditionally traumatic and non-traumatic duodenal perforations have been managed surgically. However, in the past decade the management has evolved towards a selective approach.…”

Section: Introductionmentioning

confidence: 99%

An innovative duodenal perforation surgical repair technique: the BIOPATCH technique

et al. 2018

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The treatment of duodenal perforations has scarce options and it is very difficult with an high failure rate. The aim of this work is to describe a new surgical technique that was used to treat ten patients suffering from duodenal perforation.The procedure based on the concept to enforce the duodenal suture with remodeling material allowing to the inflamed and oedematous tissues to heal without to be cut by the repairing stitches themselves, is performed with biological prosthesis patches.90% of patients treated with this innovative technique experienced a complete healing of the duodenal perforation.This unique surgical technique not only proved to be safe, but it also solved the 90% of duodenal perforations in patients at risk to die.

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Management of endoscopic retrograde cholangiopancreatography: related duodenal perforations

Cited by 95 publications

References 13 publications

Operative and non-operative management of endoscopic retrograde cholangiopancreatography-associated duodenal injuries

Operative and non-operative management of endoscopic retrograde cholangiopancreatography-associated duodenal injuries

ERCP‐related perforations in the new millennium: A large tertiary referral center 10‐year experience

An innovative duodenal perforation surgical repair technique: the BIOPATCH technique

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