The Management of Endoscopic Retrograde Cholangiopancreatography-Related Duodenal Perforation

Abstract

Uneventful duodenal perforation during endoscopic retrograde cholangiopancreatography (ERCP) is an uncommon but occasionally fatal complication. ERCP-related perforations may occur during sphincterotomy and improper manipulation of the equipment and scope. Traditionally, duodenal perforation has been treated with early surgical repair. Recently, nonoperative early endoscopic management techniques including clips or fibrin glue have been reported. In the present paper we review the literature pertaining to the treatment of perforations.

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

“…Demographics and diagnosis of patients who were not surgically treated treatment of biliary diseases (1). It has various complications, including gastrointestinal system perforation, which has significant morbidity and mortality rates (3)(4)(5)(6)(7)9). In this study, we evaluated the treatment approach to perforations and discovered that only some of these patients required surgical treatment.…”

“…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).…”

Perforations following endoscopic retrograde cholangiopancreatography (ERCP)

“…Asociado a la esfinterotomía, puede utilizarse para la extracción de cálculos, drenaje del árbol biliar y colocación de prótesis 9,10 . A pesar de ser una prueba segura, existe el riesgo de complicaciones tales como la pancreatitis, la perforación o la hemorragia [1][2][3][4][7][8][9]11,12 . La incidencia de complicaciones oscila entre el 5,4% y el 23,9% y la mortalidad del 0,1 al 1% 1,[4][5][6]8,9,11 .…”

“…A pesar de ser una prueba segura, existe el riesgo de complicaciones tales como la pancreatitis, la perforación o la hemorragia [1][2][3][4][7][8][9]11,12 . La incidencia de complicaciones oscila entre el 5,4% y el 23,9% y la mortalidad del 0,1 al 1% 1,[4][5][6]8,9,11 . La incidencia de perforación oscila entre el 1 y el 2% [3][4][5][6]11,12 y su mortalidad asciende al 16-18% según las series descritas 10 .…”

“…La incidencia de complicaciones oscila entre el 5,4% y el 23,9% y la mortalidad del 0,1 al 1% 1,[4][5][6]8,9,11 . La incidencia de perforación oscila entre el 1 y el 2% [3][4][5][6]11,12 y su mortalidad asciende al 16-18% según las series descritas 10 . De cualquier forma, la mortalidad se relaciona con el retraso en el diagnóstico y el tratamiento, que deriva en sepsis y fallo multiorgánico.…”