Surgical management of complications of endoscopic sphincterotomy with precut papillotomy

Yoo

Journal of Gastrointestinal Surgery

et al. 2009

Introduction The aim of this study was to analyze clinicoradiologic findings and treatment outcomes of patients with endoscopic retrograde cholangiopancreatography (ERCP)-related perforations. Between May 2003 and November 2007, 2,247 ERCP procedures with or without sphincterotomy were performed at Ajou University Medical Center, Suwon, Korea, and 20 perforations (0.89%) were identified. Discussion We retrospectively reviewed medical and surgical records of each patient. Of 18 patients, 11 patients (61.1%) underwent nonsurgical management, and seven patients (38.9%) received surgical management. There were no significant differences in age, gender, and laboratory findings between two groups (P>0.05). The hospital stay was significantly longer in the operative group than that of the conservative group (P<0.05, respectively). The most common cause of perforation was sphincterotomy (n=8) in the conservative group whereas scope itself (n=6) in operative group, showing a significant difference between the two groups (P<0.05). The retroperitoneal air was most common findings in eight patients (72.7%) of the conservative group, while six (85.7%) patients of the operative group presented with intraperitoneal air, displaying a significant difference in location of air between the two groups (P<0.05). Most of sphincterotomy-related perforations were managed nonsurgically. However, the scope-related perforations were usually large and required immediate surgery. Moreover, the delayed operation resulted in a longer hospital stay and high morbidity. Therefore, the selective early surgical intervention is suggested when scope-related perforations are discovered.

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Management of ERCP-Related Perforations: Outcomes of Single Institution in Korea

Yoo

Journal of Gastrointestinal Surgery

et al. 2009

“…However, over the past decade, cases of successful conservative management for carefully selected patients have been reported [6]. In this study, we present the largest published series from a single U.S. medical center of ERCP-related duodenal perforations based on clinical and radiologic criteria for presentation, location of the perforation, type of treatment, and final clinical outcome.…”

mentioning

confidence: 99%

Management of endoscopic retrograde cholangiopancreatography: related duodenal perforations

Avgerinos

Llaguna

et al. 2008

Surg Endosc

Clinical and radiographic features can be used to determine the surgical or conservative treatment of ERCP-related duodenal perforations, whereas patient age and intraoperative findings can determine the final outcome and morbidity or mortality. The interval between the perforation and the operation is of great significance. The mortality rate increases dramatically with late surgical management (>24 h). An algorithm for the selective management of ERCP-induced duodenal perforations is proposed.

Rev. Colomb. Gastroenterol.

“…En cuanto a las perforaciones tipo II, algunos autores recomiendan un tratamiento quirúrgico temprano (12), pero varios estudios recientes sugieren un tratamiento conservador, aún en casos de perforaciones retroperitoneales, que consiste en la colocación de un drenaje nasobiliar o de un stent biliar, la suspensión de la vía oral, la administración de antibióticos de amplio espectro, la nutrición parenteral y la estricta observación clínica durante 48 horas con realiza-ción de estudios tomográficos para evaluar la aparición de colecciones (10,11,13).…”

Section: Discussionunclassified

Perforación duodenal pos-CPRE de manejo no quirúrgico: reporte de un caso

M¹,

P²,

et al. 2017

La perforación duodenal posterior a la colangiopancreatografía endoscópica (CPRE) es una complicación infrecuente que sucede en un 0.1-0.6% de los casos. El manejo (quirúrgico o no quirúrgico) depende de varios factores. Presentamos el caso de una mujer que sufrió una perforación duodenal pos-CPRE manejada conservadoramente con un stent biliar metálico autoexpandible (SMAE) totalmente recubierto y antibióticos, quien no requirió manejo quirúrgico.