Background
Endoscopic retrograde cholangiopancreatography–induced perforation (EP) is a rare
but severe complication. We describe the risk factors, management, and outcome of
ERCP-induced perforations in a tertiary center.
Methods
This is a case-control study. All EP cases between March 2004 and February 2015 were
compared to a control group without perforation. Data on patients, procedures, presentation,
perforation type, radiologic findings, management, and outcome were assessed.
Results
Of 6,934 endoscopic retrograde cholangiopancreatographies, 37 patients (0.53%) had
EP. Independent risk factors included failure of cannulation, a procedure described
as “difficult,” performing a precut and resection of a periampullary adenoma. Perforation
was diagnosed during the procedure in 7 patients (19%). Median interval for diagnosis
was 11 hours (range: 0–201 hours), with 84% diagnosed within 30 hours. The periampullary
region was the most common EP site (51%). Twenty-nine patients (78%) were managed
conservatively and 8 (22%) were operated. Three patients failed conservative management
and required delayed operation. Failure of conservative management had a detrimental
effect on morbidity and duration of stay. All patients who required operative intervention
had perforation of either the duodenal free wall or the periampullary region.
Conclusion
Clear risk factors can be used to raise suspicion of EP. Early diagnosis and management
are critical for better outcome. This is especially important when operative intervention
is indicated. Nonetheless, the majority of patients may be managed conservatively.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Complications of ERCP.Gastrointest Endosc. 2012; 75: 467-473
- Complications of endoscopic biliary sphincterotomy.N Eng J Med. 1996; 335: 909-919
- Complications of endoscopic retrograde cholangiopancreatography: how to avoid and manage them.Gastroenterol Hepatol (N Y). 2013; 9: 496-504
- Endoscopic retrograde cholangiopancreatography (ERCP)-related adverse events: post-ERCP pancreatitis.Gastrointest Endosc Clin N Am. 2015; 25: 107-121
- ERCP for gallstone pancreatitis.N Engl J Med. 2014; 370: 150-157
- Incidence rates of post-ERCP complications: a systematic survey of prospective studies.Am J Gastroenterol. 2007; 102: 1781-1788
- Management of duodenal perforation post-endoscopic retrograde cholangiopancreatography. When and whom to operate and what factors determine the outcome? A review article.JOP. 2012; 13: 18-25
- Endoscopic retrograde cholangiopancreatography-related perforation: management and prevention.World J Clin Cases. 2014; 2: 522-527
- Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement.Endoscopy. 2014; 46: 693-711
- Management of duodenal perforation after endoscopic retrograde cholangiopancreatography and sphincterotomy.Ann Surg. 2000; 232: 191-198
- Decision for surgical management of perforation following endoscopic sphincterotomy.Am Surg. 1991; 57: 237-240
- Quantitative weighting of postoperative complications based on the Accordion Severity Grading System: demonstration of potential impact using the American College of Surgeons National Surgical Quality Improvement Program.J Am Coll Surg. 2010; 210: 286-298
- ERCP-related perforations: Risk factors and management.Endoscopy. 2002; 34: 293-298
- Pancreaticobiliary and duodenal perforations after periampullary endoscopic procedures.Arch Surg. 2007; 142: 448-455
- ERCP-related perforations in the new millennium: a large tertiary referral center 10-year experience.United European Gastroenterol J. 2015; 3: 25-30
- Management of duodeno-pancreato-biliary perforations after ERCP: outcome from an Italian tertiary referral center.Surg Endosc. 2013; 27: 2005-2012
- Clinical outcomes of patients who experienced perforation associated with endoscopic retrograde chlangiopancreatography.Surg Endosc. 2012; 26: 3293-3300
- Management of duodenal and pancreaticobiliary perforations associated with periampullary endoscopic procedures.Am J Surg. 2008; 196: 975-981
- Surgical management of endoscopic retrograde cholangiopancreatography-related perforations.ANZ J Surg. 2003; 73: 1011-1014
- Early precut sphincterotomy and the risk of endoscopic retrograde cholangiopancreatography related complications: an updated meta-analysis.World J Gastrointest Endosc. 2014; 6: 200-208
- Risk factors for complication following ERCP; results of a large-scale, prospective multicenter study.Endoscopy. 2007; 39: 793-801
- Perforations following endoscopic retrograde cholangiopancreatography: a single institution experience and surgical recommendations.Am J Surg. 2013; 206: 180-186
- Validity of clinical criteria in the management of endoscopic retrograde cholangiopancreatography-related duodenal perforations.Arch Surg. 2007; 142: 1059-1064
- Classificaton and management of perforations complicating endoscopic sphincterotomy.Surgery. 1999; 126: 658-663
- Postoperative Morbidity Index: a quantitative measure of severity of postoperative complications.J Am Coll Surg. 2011; 213: 616-626
Article info
Publication history
Published online: December 24, 2016
Accepted:
October 27,
2016
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
