Comparative study between biliary covered self-expandable metal stent and conventional endoscopic bile drainage treatment in endoscopic retrograde cholangiopancreatography-related Stapfer type II retroperitoneal perforations

Abstract

Background Perforation is one of the most serious complications of endoscopic retrograde cholangiopancreatography (ERCP). Conventional nonsurgical endoscopic treatments including intravenous antibiotic administration and plastic endoscopic biliary drainage are generally approved for the treatment of ERCP-related Stapfer type II perforation (perivaterian type). Biliary covered metal stent placement has recently been reported to have favorable outcomes in ERCP-related Stapfer type II perforations. We aimed to compare the outcomes of conventional endoscopic bile drainage and biliary covered self-expandable metal stent (SEMS) insertion in patients with Stapfer type II perforation. Methods Medical records of patients who underwent ERCP at Kyungpook National University Hospital in Daegu from 2011 to 2022 were retrospectively reviewed. Results A total of 8,402 ERCP procedures were performed in our hospital. Sixty-six ERCP-related perforations (0.78%) were identified. Among them, 37 patients (56.1%) who had Stapfer type II perforations were enrolled. Thirteen and twenty-four patients received biliary covered SEMS insertion and conventional endoscopic bile drainage treatments, respectively. No significant differences were observed in the clinical success rate (92.3% vs. 91.7%, p = 1.000), hospital stay (9.46 ± 5.97 vs. 13.9 ± 13.2 days, p = 0.258), and post-ERCP–related fasting time (5.4 ± 3.4 vs 4.3 ± 3.0 days, p = 0.305). Complications including bleeding, post-ERCP pancreatitis, fever, and death were not significantly different between the two groups. The conventional endoscopic bile drainage group took less time for ERCP than the SEMS group (11.5 ± 5.2 vs. 18.5 ± 11.2 min, p = 0.013). Conclusions Compared with the conventional endoscopic bile drainage treatment method, biliary covered SEMS did not improve patient outcomes in ERCP-related Stapfer type II perforations.

Comparative analysis of surgical outcomes: post-ERCP laparoscopic cholecystectomy versus elective laparoscopic cholecystectomy

“…The reported complication rate due to endoscopic precut sphincterotomy is 6.9-9.8%. [16][17][18][19][20] In our study, it was shown that precut with needle-tipped sphincterotomy increased the development of complications (p<0.05).…”

“…7,8,[16][17][18] Unstoppable bleeding from the liver bed, major vessel injuries, luminal organ injuries, and biliary tract injuries are defined as major complications. [19][20][21][22][23] The preoperative minor and major complication rates are quite variable in the literature. [18][19][20][21][22][23][24][25] In our study, bile leakage and wound infection were the most common postoperative complications.…”

“…[19][20][21][22][23] The preoperative minor and major complication rates are quite variable in the literature. [18][19][20][21][22][23][24][25] In our study, bile leakage and wound infection were the most common postoperative complications. When we evaluated group 1 and group 2 patients, there was no statistically significant difference in postoperative complications.…”

“…In our study, more than 3 repeated cannulation attempts in ERCP were termed as difficult cannulation and it was seen in 4 patients (8%). 16,[18][19][20] The presence of diverticulum was detected in 2 patients and atrophic papilla was detected in the other patients as the cause of difficult cannulation. One patient developed pancreatitis and one patient developed cholangitis after difficult cannulation.…”

“…In our study groups, the complication rate was 50% in both groups with and without difficult cannulation and the results were not statistically significant. [18][19][20] Guidewire advancement into the pancreatic duct plays a role in the development of pancreatitis with mechanical damage. Lee et al 17 reported in their prospective study that unintentional pancreatic cannulation played a role in the development of pancreatitis.…”