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

Abstract

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.

Clinical course and proposed treatment strategy for ERCP-related duodenal perforation: a multicenter analysis

“…Because the retroperitoneal space is a closed cavity, the retroperitoneal inflammation that develops after ERCP-related duodenal perforation seldom spreads rapidly into the peritoneal space. We previously reported that free intra-abdominal air and scope-related perforations could be indicators for early surgery; however, that study compared only the frequency of various clinical factors between conservative management and surgery, and the number of patients enrolled was too small for analysis of post-treatment outcome according to the clinical variables [15]. In contrast, the current study, which extended our previous study, analyzed the post-treatment survival outcomes too.…”

Early Management Experience of Perforation after ERCP

“…The immediate treatment for ERCP-related perforations affected its mortality [7, 8, 10–12]. There was no unified guideline to manipulate.…”

Successful Nonsurgical Treatment of Pneumomediastinum, Pneumothorax, Pneumoperitoneum, Pneumoretroperitoneum, and Subcutaneous Emphysema following ERCP

“…The approach to management of type II perforations is less clear. Most tend to seal spontaneously by 2-3 days, but 10–43% of patients may require surgical repair [ 10 , 15 , 29 ]. Radiographic findings that require surgery include retroperitoneal or peritoneal fluid on CT, which suggests continued bile leak from site of perforation, and are associated with worse prognosis, large contrast extravasation on ERCP or UGI, and possibly the presence of massive subcutaneous emphysema.…”