Review of duodenal perforations after endoscopic retrograde cholangiopancreatography in Hospital Puerta de Hierro from 1999 to 2014

Cubedo, Elena Jiménez; Monclús, Javier López; Poza, José Luis Lucena de la; Alcolea, Natalia González; Espino, Pablo Calvo; Pavia, Arturo García; Turrión, Víctor Sánchez

doi:10.17235/reed.2018.5255/2017

Cited by 9 publications

(6 citation statements)

References 14 publications

(7 reference statements)

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“…Distal migration of biliary plastic stents has been reported in 3-6% of cases [11][12][13], which is comparable to our result. Previous studies [14,15] indicated that the majority of distal migrated plastic stents pass spontaneously or can be retrieved endoscopically, and the frequency of duodenal perforation caused by distal migrated stents was less than 1%. A similar frequency of duodenal perforation was also noted in the present study.…”

Section: Discussionmentioning

confidence: 99%

“…Distal migration of biliary plastic stents occurs in up to 6% of cases [11][12][13]. Although less than 1% of migrated plastic stents will cause duodenal perforation [14,15], immediate endoscopic removal of the stent is usually needed once it occurs, and further surgical interventions may be indicated [7,10,16]. Considering the risks and costs, it is important to determine and avoid the risk factors of stent distal migration and its related duodenal injury.…”

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confidence: 99%

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Risk factors for distal migration of biliary plastic stents and related duodenal injury

Yuan

Liu

et al. 2019

Surg Endosc

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Background The risk factors of duodenal injury from distal migrated biliary plastic stents remain uncertain. The aim of this study was to determine the risk factors of distal migration and its related duodenal injury in patients who underwent placement of a single biliary plastic stent for biliary strictures. Methods We retrospectively reviewed all patients with biliary strictures who underwent endoscopic placement of a single biliary plastic stent from January 2006 to October 2017. Results Two hundred forty-eight patients with 402 endoscopic retrograde cholangiopancreatography procedures were included. The incidence of distal migration was 6.2%. The frequency of duodenal injury was 2.2% in all cases and 36% in cases with distal migration. Benign biliary strictures (BBS), length of the stent above the proximal end of the stricture (> 2 cm), and duration of stent retention (< 3 months) were independently associated with distal migration (p = 0.018, p = 0.009, and p = 0.016, respectively). Duodenal injury occurred more commonly in cases with larger angle (≥ 30°) between the distal end of the stent and the centerline of the patient's body (p = 0.018) or in cases with stent retention < 3 months (p = 0.031). Conclusions The risk factors of distal migration are BBS and the length of the stent above the proximal end of the stricture. The risk factor of duodenal injury due to distal migration is large angle (≥ 30°) between the distal end of the stent and the centerline of the patient's body. Distal migration and related duodenal injury are more likely to present during the early period after biliary stenting.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Risk factors for distal migration of biliary plastic stents and related duodenal injury

Yuan

Liu

et al. 2019

Surg Endosc

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“…Depending on the degree of perforation, the subsequent development of PEAL syndrome may have additional features. 5,6 The ESGE recommends an early contrast study during ERCP or CT scan, to assess for perforation in high degree of suspicion.…”

Section: Discussionmentioning

confidence: 99%

“…Other options include vacuum therapy, tulip-bundle, metallic stenting, purse-string sutures, and fibrin glue. 2,5,6 The most commonly employed tool, however, is to divert fluids from the perforation site via stenting. 9 Surgery is required in approximately one-quarter of the cases.…”

Section: Articlementioning

confidence: 99%

Post-endoscopic Retrograde Cholangiopancreatography Air Leak Syndrome: An Overview of Current Perspectives

Zameer,

Safdar,

Khan

et al. 2024

EMJ

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Post-endoscopic retrograde cholangiopancreatography (ERCP) air leak (PEAL) syndrome is a rare complication that includes pneumothorax, pneumomediastinum, pneumoperitoneum, air embolism, and subcutaneous emphysema. A 71-year-old female diagnosed with mild acute biliary pancreatitis, who underwent ERCP for stone retrieval developed neck, chest, and abdominal pain, as well as swelling of the neck, along with crepitus all along the neck and face. CT scan showed pneumoperitoneum, pneumomediastinum, and subcutaneous emphysema. The patient was diagnosed as a case of PEAL syndrome, and was managed conservatively. She ultimately underwent an uneventful cholecystectomy with peroperative stone retrieval. PEAL syndrome, albeit rare, can be a potentially life-threatening complication following ERCP, which requires continuous monitoring. It may be managed conservatively, endoscopically, or surgically.

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“…Different ERCP-induced complications with varying incidences have been reported in the literature according to the method, patient selection, and definitions of complications. The incidence of major ERCP-induced complications is as follows: 2-15.1% for pancreatitis, 0.4-10% for cholangitis, 0.1-8.6% for cholecystitis, 0.3-2% for bleeding, 0.5-2.1% for perforation, and around 1% for procedure-related mortality [2][3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Determining the Risk Factors of Complications Due to Endoscopic Retrograde Cholangiopancreatography

Özcan,

Arikan

2024

Cureus

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Background and objectiveThe effective use of endoscopic retrograde cholangiopancreatography (ERCP) has been on the rise in diagnosing and treating benign and malignant pathologies of the common bile duct and pancreas. ERCP, a complex procedure requiring high knowledge, skills, and practice, differs from other endoscopic applications as it involves the use of different techniques and equipment and the occurrence of more complications. The most commonly observed complications of ERCP are pancreatitis, bleeding, perforation, and infections. In this study, we aimed to assess the incidence of post-ERCP complications to identify the associated risk factors and indications. MethodologyIn this study, 181 ERCP procedures performed on 122 consecutive patients in the endoscopy unit of Istanbul Training Hospital were prospectively evaluated by using an observational method to determine the frequency of and risk factors for post-ERCP complications. The patients were followed up in the course of the ERCP procedure and for 30 days after the procedure; the complications and clinical developments were recorded. ResultsThe mean age of the cohort was 59.7 ± 17.7 (19-97) years; 40.9% were female and 59.1% were male. The cannulation success was achieved in 77.3% of the ERCP procedure performed. Among the ERCP procedures applied, 89% were performed for therapeutic purposes, and choledocholithiasis (60.2%) was the most common indication for ERCP. Major complications were detected in 25.4% of the patients after ERCP. The most common major complication was cholangitis (9.9%), followed by pancreatitis (7.2%), cholecystitis (5.5%), bleeding (3.9%), and perforation (1.1%). It was observed that sphincterotomy was associated with an increase in all complications. The incidence of cholangitis decreased in the presence of dilated bile ducts unrelated to obstruction. The increased incidence of pancreatitis was associated with the female gender, the use of sphincterotomy and basket, inexperienced endoscopists, and inpatient admissions. The incidence of cholecystitis, on the other hand, was found to be linked with sphincterotomy and inexperienced endoscopists. ConclusionsERCP is a complex endoscopic procedure that requires high technical knowledge and skill and can cause serious complications. For endoscopists to perform clinically effective and accurate ERCP, it is important that they correctly determine the indications for the procedure, know its potential complications, and refrain from practices that will create complications and are unnecessary as much as possible.

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Review of duodenal perforations after endoscopic retrograde cholangiopancreatography in Hospital Puerta de Hierro from 1999 to 2014

Cited by 9 publications

References 14 publications

Risk factors for distal migration of biliary plastic stents and related duodenal injury

Risk factors for distal migration of biliary plastic stents and related duodenal injury

Post-endoscopic Retrograde Cholangiopancreatography Air Leak Syndrome: An Overview of Current Perspectives

Determining the Risk Factors of Complications Due to Endoscopic Retrograde Cholangiopancreatography

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