65 Surgical or Endoscopic Management of Post-ERCP Large Duodenal Perfurations: a Multicenter Prospective Trial

Artifon, Everson Luiz de Almeida; Cunha, Marco Antonio B.; Aparicio, Dayse P.; Silveira, Edilene Aparecida Araújo da; Furuya, Carlos K.; Paione, José

doi:10.1016/j.gie.2013.04.018

Cited by 7 publications

(15 citation statements)

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“…Jin et al suggested endoscopic repair to be considered if the diagnosis was made within 6 hours [ 2 ]. Artifon et al showed in their randomized control trial of 23 patients that endoscopic repair within 12 hours was able to close the defect as safely and effectively as a surgical approach [ 20 ]. The study did not characterize the perforations based on Stapfer classification; however, it was mentioned that approximately 40% were intraperitoneal.…”

Section: Discussionmentioning

confidence: 99%

A Case of Unresolved and Worsening Retroperitoneal Abscess

Bansal

Barakat

Chun

et al. 2018

Case Reports in Gastrointestinal Medicine

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Retroperitoneal abscess is a rare condition which is difficult to diagnose and treat because of its insidious onset. Herein, we present a case of retroperitoneal abscess secondary to a perforation that occurred during an ERCP. A 54-year-old female patient was admitted to an outside hospital with gallstone pancreatitis and underwent ERCP with sphincterotomy followed by laparoscopic cholecystectomy. An abdominal CT scan was performed at the outside hospital 10 days later for worsening abdominal pain which showed multiple loculated pockets in the right upper and lower quadrant. Her condition improved after IV antibiotics and percutaneous drainage. Her symptoms recurred a month later and she presented to our hospital. Repeat abdominal CT scan at our hospital revealed recurrence of her abscesses. Multiple drains were placed and the abscess cavity was washed out without much improvement. EGD revealed a small mucosal defect in the distal portion of the duodenal bulb which was closed successfully using an over-the-scope clip. Repeat CT scan after 8 weeks from the endoscopic closure showed near complete resolution of the abscess. ERCP-associated perforation is a rare complication and can be challenging to diagnose and treat; prompt recognition is mandatory for favorable prognosis. Our patient was managed successfully via nonsurgical approach.

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Section: Discussionmentioning

confidence: 99%

A Case of Unresolved and Worsening Retroperitoneal Abscess

Bansal

Barakat

Chun

et al. 2018

Case Reports in Gastrointestinal Medicine

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“…Iatrogenic perforation during the procedure remains a feared adverse event and the prompt recognition often mitigates the need for surgical intervention. Artifon et al 13 presented a randomized, controlled trial comparing endoscopic and surgical management of transmural duodenal perforations incurred during ERCP. In this multicenter study of 4100 ERCP procedures, patients with duodenal perforation were randomized to endoscopic (n = 12) or surgical (n = 11) intervention.…”

Section: Pancreatobiliary Endoscopic Treatmentmentioning

confidence: 99%

“…Iatrogenic perforation during the procedure remains a feared adverse event and the prompt recognition often mitigates the need for surgical intervention. Artifon et al . presented a randomized, controlled trial comparing endoscopic and surgical management of transmural duodenal perforations incurred during ERCP.…”

Section: Pancreatobiliary Endoscopic Treatmentmentioning

confidence: 99%

Evolving endoscopic surgery

Sakai

Faintuch

2014

J of Gastro and Hepatol

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Since the days of Albukasim in medieval Spain, natural orifices have been regarded not only as a rather repugnant source of bodily odors, fluids and excreta, but also as a convenient invitation to explore and treat the inner passages of the organism. However, surgical ingenuity needed to be matched by appropriate tools and devices. Lack of technologically advanced instrumentation was a strong deterrent during almost a millennium until recent decades when a quantum jump materialized. Endoscopic surgery is currently a vibrant and growing subspecialty, which successfully handles millions of patients every year. Additional opportunities lie ahead which might benefit millions more, however, requiring even more sophisticated apparatuses, particularly in the field of robotics, artificial intelligence, and tissue repair (surgical suturing). This is a particularly exciting and worthwhile challenge, namely of larger and safer endoscopic interventions, followed by seamless and scarless recovery. In synthesis, the future is widely open for those who use together intelligence and creativity to develop new prototypes, new accessories and new techniques. Yet there are many challenges in the path of endoscopic surgery. In this new era of robotic endoscopy, one will likely need a virtual simulator to train and assess the performance of younger doctors. More evidence will be essential in multiple evolving fields, particularly to elucidate whether more ambitious and complex pathways, such as intrathoracic and intraperitoneal surgery via natural orifice transluminal endoscopic surgery (NOTES), are superior or not to conventional techniques.

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“…More importantly, it appears that the majority of perforations occur secondary to sphincterotomy, which is generally considered less worrisome than perforations of the lateral duodenal wall. Artifon et al [18] presented a randomized, controlled trial comparing endoscopic and surgical management of the transmural duodenal perforations incurred during ERCP. In this multicenter study of 4100 ERCP procedures, nearly 25 patients with transmural duodenal perforations were randomized to endoscopic (n = 12) or surgical (n = 11) intervention.…”

Section: Ercp-related Perforations !mentioning

confidence: 99%

Ercp

Law

Baron

2013

Endoscopy

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DDW Highlights 745Prevention of post-ERCP pancreatitis ! The concept of hypoperfusion of the microvasculature during the early phase of acute pancreatitis has led to the emphasis on early volume resuscitation, specifically Ringer's lactate solution for acute pancreatitis of any cause to prevent or limit pancreatic injury. Although prevention of PEP has focused on pharmacologic agents (most recently NSAIDs) and PD stents, Buxbaum et al [1] reported the interim results on the use of aggressive hydration to prevent PEP. Patients were prospectively randomized in a 2:1 ratio of aggressive hydration compared with moderate hydration. Aggressive hydration was administered by using lactated Ringer's (LR) solution at 3 mL/kg/h intraprocedurally followed by a bolus of LR 20 mg/kg administered immediately postprocedurally, and continued at 3 mL/kg/h for 8 hours. In the standard hydration group LR was administered at 1.5 mL/kg/ h during the procedure and for 8 hours afterward. Patients were monitored for volume overload, and PEP was defined by using standard criteria. PEP developed in none of the 32 patients in the aggressive fluid arm compared with 4 of 32 (24 %) in the moderate fluid arm. No volume overload occurred. These results suggest that aggressive fluid resuscitation should be considered in all patients who are not at risk of volume overload because this intervention poses little risk otherwise. Cannulation techniques continue to be important because difficult cannulation is associated with an increased risk of PEP. There continues to be a shift from contrast-guided biliary cannulation to wire-guided (WG) cannulation. Two abstracts of note focused on cannulation techniques. When WG cannulation fails, but the guidewire unintentionally and repeatedly enters the main pancreatic duct (PD), 1 option is to leave the guidewire in the pancreas and reattempt biliary cannulation alongside with a second guidewire and catheter. This is termed double wire -guided (DWG) cannulation. Sasahara et al [2] presented results of a randomized trial comparing early DWG cannulation, in which a guidewire remained in the PD after the first unintentional entry compared with repeated conventional WG biliary cannulation in patients undergoing therapeutic endoscopic retrograde cholangiography. Successful biliary cannulation was achieved in 48 % of patients on the first attempt, with a PEP rate of only 4 %. The subsequent 274 patients (137 per group) were defined as difficult cannulation and were randomized. Common bile duct cannulation was successful within 10 minutes or 10 attempts in 75 % of patients in the early DWG group and 70 % of the repeated single WG cannulation group. The final cannulation rate was approximately 97 % in each group with a similar rate of PEP (20 % vs 17 %). No mention was made of the use of prophylactic pancreatic stents or pharmacologic agents. This suggests that the PEP rate in patients with difficult cannulation remains high if PD stent placement and/or NSAIDs are not used, but that DWG cannulation is associated with ...

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65 Surgical or Endoscopic Management of Post-ERCP Large Duodenal Perfurations: a Multicenter Prospective Trial

Cited by 7 publications

References 0 publications

A Case of Unresolved and Worsening Retroperitoneal Abscess

A Case of Unresolved and Worsening Retroperitoneal Abscess

Evolving endoscopic surgery

Ercp

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