ERCP-related perforation: an analysis of operative outcomes in a large series over 12 years

Patil, Nilesh; Solanki, Nisha; Mishra, Pramod Kumar; Sharma, Barjesh Chander; Saluja, Sundeep Singh

doi:10.1007/s00464-019-06733-x

Cited by 27 publications

(36 citation statements)

References 27 publications

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“…Surgical intervention is warranted in patients with overt signs of peritonitis, large intra/retro-peritoneal air, hemodynamic instability, or failure of medical management. Surgical management primarily involves draining intra and retroperitoneal fluid collections, primary repair of the perforation with or without duodenal diversion [7].…”

Section: Discussionmentioning

confidence: 99%

“…Alternative procedures that might have been tried in the emergency setting were a primary repair of the perforation with pyloric exclusion with/without biliary drainage but the rates of mortality and postoperative duodenal leaks in such cases are extremely high [7]. Further, this would have deferred the definitive procedure.…”

Section: No Author Age Sex Interventionmentioning

confidence: 99%

“…Delay in treatment of more than 24 hours after the perforation can result in doubling of mortality rates. The management of EP is not standardized in view of the low incidence of this complication and the heterogeneity of the patient population experiencing this procedure with respect to the site, type, presentation, and comorbidities [7].…”

Section: No Author Age Sex Interventionmentioning

confidence: 99%

See 2 more Smart Citations

Emergency Pancreatoduodenectomy for Ampullary Cancer Post-Iatrogenic Duodenal Perforation: No Option but to Strike

Varshney¹,

Nayar²,

Sreesanth³

et al. 2020

Cureus

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Endoscopic retrograde cholangiography related duodenal perforation is an infrequent complication and associated with significant morbidity. The management of such perforations, especially in the setting of malignancy, is not standardized given the paucity of literature. We encountered a patient who was diagnosed with periampullary carcinoma and had a perforation in the duodenum during endoscopy. Emergency pancreatoduodenectomy (EPD) was performed considering it to be a resectable disease with minimal contamination. He had a prolonged hospital course due to surgical site infection and hepaticojejunostomy leak, however, which was managed successfully. At one year follow up, he is healthy with no evidence of recurrence. We conclude that EPD can be attempted for selected iatrogenic duodenal perforations with co-existent resectable malignancy in a stable patient. It may help to avoid the morbidity of a second surgery in the setting of a distorted anatomy and simultaneously preventing the probable upstaging of disease due to peritoneal seedling.

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Section: Discussionmentioning

confidence: 99%

Section: No Author Age Sex Interventionmentioning

confidence: 99%

Section: No Author Age Sex Interventionmentioning

confidence: 99%

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Emergency Pancreatoduodenectomy for Ampullary Cancer Post-Iatrogenic Duodenal Perforation: No Option but to Strike

Varshney¹,

Nayar²,

Sreesanth³

et al. 2020

Cureus

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“…Site of perforation. Retroperitoneal duodenal perforation from endoscopic retrograde cholangiopancreatography (ERCP) intervention is different and limited than free Meckel's diverticulum perforation [18].…”

Section: Presentation Diversitymentioning

confidence: 99%

Gastrointestinal Tract Leak: Is It One Entity or Spectrum of Conditions?

Tuma

2020

Cureus

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Gastrointestinal (GI) leak is a well-known and catastrophic surgical complication. Its impact on patients, surgeons, and the healthcare system is tremendous. Efforts to constraint the occurrence and consequences of GI leak contributed to better assessment and management planning, especially with advanced technology. Detail information about the problem extent and new management options became available and effective for specific categories. Therefore, a full and accurate assessment and understanding of the disease presentation assists in choosing the appropriate management plan. The pathophysiologic process encompasses a severe inflammatory process with a superimposed infection inside sterile body tissue and cavities initiated by contaminated GI leaked content. The extent of the morbidity resulting from GI perforation and leak is variable and may not be predictable. Leak might not be the same in every case. Patients with GI leak present at variable severity depending on several factors. Accordingly, management should be individualized to target the underlying pathophysiology and the extent of the complication. Operative intervention and repair of the perforation site surgically or endoscopically are the standard of care frequently used. However, it may not always be needed. In this article, a practical review of the diversity and underlying pathologies of GI leak will be presented to inform case-specific management plans.

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“…Iatrogenic ERCP-related duodenal perforation is a rare and fatal complication of ERCP, and the incidence ranges from 0.29% to 3.5% [4][5][6][7][8][9][10][11][12][13][14][15][16], but the highest reported mortality rate is 34.4% [13]. Due to the low incidence and high mortality, there are few large multi-centre cases.…”

Section: Introductionmentioning

confidence: 99%

Recent advances in prevention and management of endoscopic retrograde cholangiopancreatography-related duodenal perforation.

Zhu

Wang

2020

Videosurgery and Other Miniinvasive Techniques

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Endoscopic retrograde cholangiopancreatography (ERCP) is the main diagnosis and treatment for biliary and pancreatic diseases; however, ERCP requires a high level of technical skill and experience, and there is always a risk of complications. ERCP-related duodenal perforation is one of the most serious complications of ERCP, and although the incidence rate is relatively low, the mortality rate is high. Recently, the introduction of new classification methods and the development of endoscopic technology and equipment have made endoscopic therapy a new trend. This may change the management strategy of perforation. Therefore, we reviewed the latest developments in endoscopic management, surgical management, and conservative internal medicine management. In addition to introducing many new endoscope treatment methods, we also discussed the timing of interventions, the progress of endoscope and surgical indications, and corresponding prevention strategies. We aim to retrospectively analyse these treatment modalities to propose appropriate solutions to improve dynamic clinical therapy.

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ERCP-related perforation: an analysis of operative outcomes in a large series over 12 years

Cited by 27 publications

References 27 publications

Emergency Pancreatoduodenectomy for Ampullary Cancer Post-Iatrogenic Duodenal Perforation: No Option but to Strike

Emergency Pancreatoduodenectomy for Ampullary Cancer Post-Iatrogenic Duodenal Perforation: No Option but to Strike

Gastrointestinal Tract Leak: Is It One Entity or Spectrum of Conditions?

Recent advances in prevention and management of endoscopic retrograde cholangiopancreatography-related duodenal perforation.

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