Duodenal Perforations After Endoscopic Retrograde Cholangiopancreatography

Abstract Introduction Duodenal perforations after endoscopic retrograde cholangiopancreatography (ERCP) are an uncommon complication. The management of this kind of perforation is controversial. The aim of this study was to analyze the results of the management of a series of 15 patients who were di...

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Published in:Cirugia española (English ed.) 2015-06, Vol.93 (6), p.403-410
Main Authors: Armas Ojeda, María Desirée, Ojeda Marrero, Vanesa, Roque Castellano, Cristina, Cabrera Marrero, José Carlos, Mathías Gutierrez, María del Pino, Ceballos Santos, Daniel, Marchena Gómez, Joaquín
Format: Article
Language:English
Subjects:
Colangiografía retrógrada endoscópica
Complicaciones
Complications
Endoscopic retrograde cholangiopancreatography
Perforación
Perforation
Surgery
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Summary:Abstract Introduction Duodenal perforations after endoscopic retrograde cholangiopancreatography (ERCP) are an uncommon complication. The management of this kind of perforation is controversial. The aim of this study was to analyze the results of the management of a series of 15 patients who were diagnosed with this complication. Methods Retrospective study of duodenal perforations after ERCP diagnosed at a tertiary level hospital, between 2001 and 2011. The variables age, sex, ERCP indication, type of perforation, time of diagnosis, clinical presentation, radiographic findings, management, surgical technique, length of stay and intrahospital mortality were recorded and analyzed. Results Out of a total of 1923 ERCP performed, 15 duodenal perforations were detected (0.78%). Perforation site was the duodenal wall (3 cases) and periampullary (12 cases). Eleven perforations were suspected during the procedure. Patients with duodenal wall perforations underwent immediate surgery. Seven of 12 periampullary perforations were managed conservatively with a favourable outcome in 5 of them. Subsequent scheduled surgery was performed in 4 cases. The mean length of hospital stay was 21.2 days (range: 3–49) and intrahospital mortality was 20%. Conclusions Perforations after ERCP have high mortality rates, and require a complicated therapeutic approach that needs to be individualized. Selective conservative management is a valid and safe option in selected patients.
ISSN:2173-5077
2173-5077
DOI:10.1016/j.cireng.2015.01.004