BACKGROUND: The management of endoscopic retrograde cholangiopancreatography (ERCP)-related perforations remains controversial. Τhe aim of the study was to determine the incidence of perforations following ERCP, their characteristics, operative and non-operative management options and clinical outcome. METHODS: A retrospective review of ERCP-related perforations, during a 21-year period, was performed. Each perforation was categorized into types I to IV according to the location, mechanism and radiographic evaluation of the injury. Comparisons were made between patients treated operatively and non-operatively. RESULTS: Forty-four perforations (0.4%) occurred in 9,880 procedures. They were mainly caused by the passage of the endoscope (type I) in 7 (16%) and sphincterotomy (type II) in 30 (68%) patients. The management was non-operative in 32 (72%) and operative in 12 patients. In multivariate analysis, only the type of perforation (type I: endoscope-related) was found significant for predicting operative treatment. The hospital stay was longer for patients requiring an operation (median, 24 vs 9 days). The overall mortality was 2/44 (4.5%). There was no death in the non-operative group. CONCLUSIONS: The need for immediate operative intervention should be based on the type of injury and clinical findings. Patients with type I perforations should be treated surgically and primary repair should be tried. Patients with type II injuries may be treated initially non-operatively. Delayed operative intervention will be required in a minority of these patients.
BACKGROUND: The management of endoscopic retrograde cholangiopancreatography (ERCP)-related perforations remains controversial. Τhe aim of the study was to determine the incidence of perforations following ERCP, their characteristics, operative and non-operative management options and clinical outcome. METHODS: A retrospective review of ERCP-related perforations, during a 21-year period, was performed. Each perforation was categorized into types I to IV according to the location, mechanism and radiographic evaluation of the injury. Comparisons were made between patients treated operatively and non-operatively. RESULTS: Forty-four perforations (0.4%) occurred in 9,880 procedures. They were mainly caused by the passage of the endoscope (type I) in 7 (16%) and sphincterotomy (type II) in 30 (68%) patients. The management was non-operative in 32 (72%) and operative in 12 patients. In multivariate analysis, only the type of perforation (type I: endoscope-related) was found significant for predicting operative treatment. The hospital stay was longer for patients requiring an operation (median, 24 vs 9 days). The overall mortality was 2/44 (4.5%). There was no death in the non-operative group. CONCLUSIONS: The need for immediate operative intervention should be based on the type of injury and clinical findings. Patients with type I perforations should be treated surgically and primary repair should be tried. Patients with type II injuries may be treated initially non-operatively. Delayed operative intervention will be required in a minority of these patients.
Authors: Madhukumar Preetha; Yaw-Fui A Chung; Weng-Hoong Chan; Hock-Soo Ong; Pierce K H Chow; Wai-Keong Wong; London L P J Ooi; Khee-Chee Soo Journal: ANZ J Surg Date: 2003-12 Impact factor: 1.872
Authors: Kelly Knudson; Christopher D Raeburn; Robert C McIntyre; Raj J Shah; Raj J Shaw; Yang K Chen; William R Brown; Gregory Stiegmann Journal: Am J Surg Date: 2008-12 Impact factor: 2.565
Authors: Javairiah Fatima; Todd H Baron; Mark D Topazian; Scott G Houghton; Corey W Iqbal; Beverly J Ott; David R Farley; Michael B Farnell; Michael G Sarr Journal: Arch Surg Date: 2007-05
Authors: Jason G Bill; Zachary Smith; Joseph Brancheck; Jeffrey Elsner; Paul Hobbs; Gabriel D Lang; Dayna S Early; Koushik Das; Thomas Hollander; Maria B Majella Doyle; Ryan C Fields; William G Hawkins; Steven M Strasberg; Chet Hammill; William C Chapman; Steven Edmundowicz; Daniel K Mullady; Vladimir M Kushnir Journal: Surg Endosc Date: 2018-05-16 Impact factor: 4.584