Fully covered self-expandable metal stent for intraprocedural or late-diagnosed Type-II endoscopic retrograde cholangiopancreatography-related perforations

Abstract

Background Perforations related to endoscopic retrograde cholangiopancreatography (ERCP) are rare but life-threatening complications. The treatment of Type-II-periampullary perforations that develop during endoscopic sphincterotomy remains a topic of discussion. This study aimed to evaluate the usefulness of fully covered self-expanding metal stenting (FCSEMS) for treating Type-II perforations. Methods The files of all patients who underwent the ERCP procedures between January 2015 and October 2021 were retrospectively reviewed; patients with Stapher Type-II perforation were included in the current study. Patients with FCSEMS were classified into two groups: those who underwent FCSEMS and those who were conventionally followed up. Moreover, patients with FCSEMS were classified into two subgroups: those who underwent simultaneous stenting and those who underwent late stenting. Mortality, surgical intervention, percutaneous drainage, length of hospital stay, and inflammatory markers were all compared between the groups. Results Of the 9253 patients undergoing ERCP during the study period, 28 patients (0.3%) were found to have Type-II perforation. The mean age of these patients was 67.7 ± 3.9 years, and 15 patients were female. FCSEMS was performed on 19 patients, whereas 9 patients were on conventional follow-up. None of the patients developed mortality. In the conventional follow-up group, one patient required percutaneous drainage and one required surgical intervention. In contrast, none of the patients in the FCSEMS group required additional intervention. At a statistically significant level, the length of hospital stay was found to be shorter in the FCSEMS group. There was no difference in inflammatory markers between the two groups. In nine patients, FCSEMS was performed simultaneously, whereas, in ten patients, FCSEMS was performed later because they required a second intervention. These two subgroups did not differ in terms of outcomes. Conclusions FCSEMS is a safe and effective treatment modality for patients with Type-II perforation. Moreover, it can be safely used in patients whose perforations are diagnosed during the ERCP procedure and in patients whose diagnoses are made after the procedure.

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

“…Recent studies have demonstrated the successful treatment of Stapfer type II perforations by inserting covered metal stents instead of surgical treatment [ 3 , 9 ]. In theory, the covered metal stent could block the leakage of fluid from the lesion into the retroperitoneal cavity by closing the perforated hole, thereby reducing the inflammatory response and accelerating healing.…”

“…In theory, the covered metal stent could block the leakage of fluid from the lesion into the retroperitoneal cavity by closing the perforated hole, thereby reducing the inflammatory response and accelerating healing. Bozbiyik et al retrospectively compared SEMS (fully covered type, n = 19) with conventional treatment (n = 9) in type II ERCP perforation [ 9 ]. In this study, the conventional treatment included NPO, intravenous antibiotic administration, and close monitoring without other biliary drainage.…”

“…Either simultaneous or late SEMS insertion did not require surgical or percutaneous drainage intervention. Additionally, a significant difference in hospital stay was noted between the two groups [ 9 ]. In our study, one late plastic ERBD insertion case was noted, which was conducted the day following ERCP-related perforation.…”

“…In particular, if accompanied by perforation, the prognosis is expected to be worse. Previous studies have reported that the prevalence of post ERCP pancreatitis in cases of post ERCP perforation is 10–43% [ 3 , 9 , 15 ]. Compared to previous studies, this study confirmed that the prevalence of post ERCP pancreatitis was very low at 1 in 37 cases (2.7%).…”

Exerting Forces and Wall Load during Duodenoscopy for ERCP: An Experimental Measurement in an Artificial Model

“…Endoscopic negative pressure therapy may help with secondary wound healing [15,16]. The use of fully covered self-expandable metal stents (FC-SEMS) for iatrogenic perforations related to ERCP is another treatment option used to seal the defect [17].…”