Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Management of endoscopic retrograde cholangiopancreatography: related duodenal perforations

  • 695 Accesses

  • 58 Citations

Abstract

Background

As the performance of upper gastrointestinal endoscopy, especially endoscopic retrograde cholangiopancreatography (ERCP), has increased since 1968, so has the incidence of duodenal perforations. The frequency of ERCP use varies among hospitals and depends on the availability of trained endocopists, equipment, and facilities.

Methods

A retrospective review of ERCP-related perforations to the duodenum was conducted to identify their incidence, optimal management, and clinical outcome. Charts were reviewed for the following data: ERCP indication, clinical presentation, diagnostic methods, time to diagnosis and treatment, type of injury, management, length of hospital stay, and clinical outcome.

Results

From April 1999 to February 2008, 4,358 ERCP were performed, 15 of which (0.34%) resulted in perforation to the duodenum. Only four of the perforations were discovered during ERCP, with another eight requiring computed tomography or abdominal radiography for diagnosis. Surgery was performed for 13 of the patients (87%), and 2 patients died (15%). One patient was managed conservatively with a successful outcome. Nine patients underwent surgery within 24 h after the ERCP, with only one patient undergoing surgery after 24 h. The overall mortality rate was 20% (3 of 15 patients).

Conclusions

Clinical and radiographic features can be used to determine the surgical or conservative treatment of ERCP-related duodenal perforations, whereas patient age and intraoperative findings can determine the final outcome and morbidity or mortality. The interval between the perforation and the operation is of great significance. The mortality rate increases dramatically with late surgical management (>24 h). An algorithm for the selective management of ERCP-induced duodenal perforations is proposed.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. 1.

    Barthet M, Lesavre N, Desjeux A, Gasmi M, Berthezene P, Berdah S, Viviand X, Grimaud JC (2002) Complications of endoscopic sphincterotomy: results from a single tertiary referral center. Endoscopy 34:991–997

  2. 2.

    Enns R, Eloubeidi MA, Mergener K, Jowell PS, Branch MS, Pappas TM, Baillie J (2002) ERCP-related perforations: risk factors and management. Endosocpy 34:293–298

  3. 3.

    Freeman ML, Nelson DB, Sharman S, Haber GB, Herman ME, Dorsher PJ, Moore JP, Fennerty MB, Ryan ME, Shaw MJ, Lande JD, Pheley AM (1999) Complications of endoscopic biliary sphincterotomy. N Engl J Med 335:909–918

  4. 4.

    Martin DF, Tweedle DE (1990) Retroperitoneal perforation during ERCP and endoscopic sphincterotomy: causes, clinical features, and management. Endoscopy 22:174–175

  5. 5.

    Stapfer M, Selby RR, Stain SC, Kathouda N, Parekh D, Jabbour N, Garry D (2000) Management of duodenal perforation after endoscopic retrograde cholagio-pancreatography and sphincterotomy. Ann Surg 232:191–198

  6. 6.

    Booth FV, Doerr RJ, Khalafi RS, Luchette FA, Flint LM (1990) Surgical management of complications of endoscopic sphincterotomy with precut papillotomy. Am J Surg 159:132–136

  7. 7.

    Cotton PB, Lehman G, Vennes J, Greenen JE, Russell RC, Meyers WC, Liguory C, Nickl N (1991) Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc 37:383–393

  8. 8.

    Dunham F, Bourgeouis N, Gelin M, Jeanmart J, Toussaint J, Cremer M (1982) Retroperitoneal perforations following endoscopic sphincterotomy: clinical course and management. Endoscopy 14:92–96

  9. 9.

    Lizcano JGC, Martin JAG, Arino JM, Sola AP (2004) Complications of endoscopic retrograde cholagiopancreatography: a study in a small ERCP unit. Rev Esp Enferm Dig 96:163–173

  10. 10.

    Preetha M, Chung YF, Chan WH, Ong HS, Chow PK, Wong WK, Ooi LL, Soo KC (2003) Surgical management of endoscopic retrograde cholagiopancreatography-related perforations. ANZ J Surg 73:1011–1014

  11. 11.

    Howard TJ, Lehman GA, Sherman S, Madura JA, Fogel E, Swack ML, Kopecky KK (1999) Classification and management of perforations complicating endoscopic sphincterotomy. Surgery 126:658–665

  12. 12.

    Assalia A, Suissa A, Ilivitzki A, Mahajna A, Yassin K, Hashmonai M, Krausz MM (2007) Validity of clinical criteria in the management of endoscopic retrograde cholagiopancreatography-related duodenal perforations. Arch Surg 142:1059–1064

Download references

Author information

Correspondence to I. Michael Leitman.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Avgerinos, D.V., Llaguna, O.H., Lo, A.Y. et al. Management of endoscopic retrograde cholangiopancreatography: related duodenal perforations. Surg Endosc 23, 833 (2009). https://doi.org/10.1007/s00464-008-0157-9

Download citation

Keywords

  • Conservative management
  • Endoscopic retrograde cholangiopancreatography
  • Perforation
  • Surgical management