Immediate detection of endoscopic retrograde cholangiopancreatography-related periampullary perforation: Fluoroscopy or endoscopy?

Motomura, Yasuaki; Akahoshi, Kazuya; Gibo, Junya; Kanayama, Kenji; Fukuda, Shinichiro; Hamada, Shouhei; Otsuka, Yoshihiro; Kubokawa, Masaru; Kawakami, Kiyoshi; Nakamura, Kazuhiko

doi:10.3748/wjg.v20.i42.15797

Cited by 12 publications

(13 citation statements)

References 23 publications

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“…It is therefore not surprising to see that all of our patients in the fluid‐alone group were diagnosed after the procedure and has more time elapsed before the diagnosis. While it is well documented that early perforation diagnosis is associated with better prognosis, in our study, we found that although all the patients in the fluid‐alone group were diagnosed late, most of them only required medical treatment and had a shorter mean hospital stay than those in the air‐fluid group. We thus suggest that, in addition to early diagnosis, the prognosis of an ERP depends on the location and the size of the perforation.…”

Section: Discussioncontrasting

confidence: 61%

Computed tomography classification of endoscopic retrograde cholangiopancreatography‐related perforation

Tsai

Chen

et al. 2019

The Kaohsiung J of Med Scie

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Endoscopic retrograde cholangiopancreatography (ERCP)-related perforation leads to high morbidity and mortality. The Stapfer classification divides patients with different perforation locations and suggests management accordingly. The classification may be unknown if perforation is not detected during endoscopy. We classified patients with ERCP-related perforation (ERP) through computed tomography (CT) and observed the clinical outcomes with varyingly invasive management. Fifty-two cases of ERP between July 2009 and December 2017 were retrospectively reviewed. Of them, 41 who underwent CT for ERCP were included. According to their CT findings, we divided patients into air-alone (n = 16), air-fluid (n = 18), and fluid-alone (n = 7) groups. Perforation severity was graded using the Clavien-Dindo classification for surgical complications. Demographic data and clinical outcomes among different groups were analyzed. Fifteen patients (37%) had an unknown Stapfer classification. More than half of the patients in the air-fluid group had a Clavien-Dindo complication grade of >3. Four patients underwent surgical repair; all of them were from the airfluid group. All patients in the air-and fluid-alone groups underwent medical treatment without need for subsequent salvage surgery. The air-fluid group had the longest mean hospital stay (25.1 ± 21.9 days) and the exclusive two mortality cases in this study. Patients with ERCP can be divided into groups with different outcomes according to the presence of air or fluid on CT images. Because patients with both air and fluid have the worst clinical outcome, they may require more aggressive treatment than patients with either air or fluid alone. K E Y W O R D S air, computed tomography, endoscopic retrograde cholangiopancreatography, fluid, perforation 1 | INTRODUCTION Complications from endoscopic retrograde cholangiopancreatography (ERCP) include cholangitis, pancreatitis, bleeding, and perforation. The likelihood of these complications is 5%-12% in all cases, and they can increase morbidity and mortality. 1 Among these complications, endoscopic retrograde cholangiopancreatography-related perforation (ERP)remains a clinical challenge to endoscopists because it may be overlooked during these procedures and there is no consensus on its management. Overall, the incidence of ERP is approximately 0.1%-1.6% 2,3 with a mortality rate of 3%-35.7%. 4,5 Surgical debridement and repair is the mainstay of treatment options for ERP. It is, however, associated with high morbidity and mortality; recent studies have suggested more conservative treatment for certain

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Section: Discussioncontrasting

confidence: 61%

Computed tomography classification of endoscopic retrograde cholangiopancreatography‐related perforation

Tsai

Chen

et al. 2019

The Kaohsiung J of Med Scie

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“…Traditionally, an early or immediate diagnosis of ERCP-related perforation has depended mostly on the use of either video endoscopy or digital fluoroscopy. 2 In the cases described by Kumbhari et al, the intraprocedural detection rate of duodenal perforation is approximately 10%, which we believe is too low. This implies that only a small portion of the included patients received immediate diagnoses of ERCP-related perforation under fluoroscopy or duodenoscopy.…”

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confidence: 66%

“…If the result of the "safety injection" is normal, then no further intervention is necessary because the patient may have a Stapfer type IV perforation, which does not require therapy. [2][3][4]…”

Section: Responsementioning

confidence: 99%

“…According to published reports, an immediate diagnosis of ERCPrelated perforation is made at a rate of approximately 66% to 96.7%. 2 Free air leakage as a negative enhancement may be more important because it provides prompt information, which may offer up suspicion of a biliary perforation. The identification of free air around the common bile duct, falciform ligament, and retroperitoneum are the key factors for an early diagnosis of ERCP-induced perforation.…”

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confidence: 99%

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Immediate diagnosis of ERCP-related perforation: by air, contrast medium, or eyes

Peng

Chow

2017

Gastrointestinal Endoscopy

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“…A C-vision Safire or Sonialvision Safire digital fluoroscope (Shimadzu Corporation, Kyoto, Japan) and a JF-260 or TJF-240 video endoscope (Olympus, Tokyo, Japan) with CO 2 instead of standard air insufflation were used in all procedures [22].…”

Section: Endoscopic Retrograde Cholangio-pancreatography and Peroral mentioning

confidence: 99%

Utility of lavage cytology plus targeted biopsy during cholangioscopy for the diagnosis of indeterminate biliary lesions

Motomura¹,

Akahoshi²,

Kawakami³

et al. 2017

Gastroenterol Hepatol Endosc

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Immediate detection of endoscopic retrograde cholangiopancreatography-related periampullary perforation: Fluoroscopy or endoscopy?

Abstract: ERCP-related perforations may be difficult to diagnose by video endoscope and digital fluoroscope detection of retroperitoneal free air or contrast medium leakage can facilitate diagnosis.

Cited by 12 publications

References 23 publications

Computed tomography classification of endoscopic retrograde cholangiopancreatography‐related perforation

Computed tomography classification of endoscopic retrograde cholangiopancreatography‐related perforation

Immediate diagnosis of ERCP-related perforation: by air, contrast medium, or eyes

Utility of lavage cytology plus targeted biopsy during cholangioscopy for the diagnosis of indeterminate biliary lesions

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