The importance of early recognition in management of ERCP-related perforations. Surg Endosc 2018 Dec;32(12):4841-4849
Date
05/18/2018Pubmed ID
29770887DOI
10.1007/s00464-018-6235-8Scopus ID
2-s2.0-85047160519 (requires institutional sign-in at Scopus site) 17 CitationsAbstract
BACKGROUND: Iatrogenic perforations related to endoscopic retrograde cholangiopancreatography (ERCP) are rare events, carrying with it a mortality of up to 8%. Given the rarity of this adverse event, there remains limited data and continued uncertainties when choosing therapeutic strategies. Our aims were to evaluate the management of ERCP-related perforations and compare outcomes based on timing of recognition.
METHODS: The endoscopic databases of two tertiary care centers were interrogated to identify consecutive adult patients who sustained ERCP-related perforation over a 10-year period from 2006 to 2016. Electronic medical records were reviewed to extract demographic data, perforation type, management strategies, clinical data, and patient outcomes.
RESULTS: 14,045 ERCP's were performed during our 10-year study period. Sixty-three patients (average age 62.3 ± 2.38 years, 76% female) with ERCP-related perforations were included. Stapfer I perforations were found in 14 (22.2%) patients, Stapfer II in 24 (38.1%), and Stapfer III and IV perforations were identified in 16 (25.4%) and 9 (14.28%), respectively. Forty-seven (74.6%) perforations were recognized immediately during the ERCP, whereas 16 (25.4%) were recognized late. Endoscopic therapy was attempted in 35 patients in whom perforations were identified immediately, and was technically successful in 33 (94.3%). In all, 4 (1 immediate/ 3 delayed) patients required percutaneous drainage and 9 (5 immediate/ 4 delayed) surgery. Length of hospital stay, ICU admission were significantly shorter and incidence of SIRS was significantly lower when perforation was recognized immediately.
CONCLUSIONS: Immediate recognition of ERCP-related perforations leads to more favorable patient outcomes; with lower incidence of SIRS, less need for ICU level care, and shorter hospital stay.
Author List
Bill JG, Smith Z, Brancheck J, Elsner J, Hobbs P, Lang GD, Early DS, Das K, Hollander T, Doyle MBM, Fields RC, Hawkins WG, Strasberg SM, Hammill C, Chapman WC, Edmundowicz S, Mullady DK, Kushnir VMAuthor
Zachary Smith DO Associate Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Cholangiopancreatography, Endoscopic RetrogradeDelayed Diagnosis
Drainage
Female
Humans
Intensive Care Units
Intestinal Perforation
Length of Stay
Male
Middle Aged
Patient Admission
Retrospective Studies
Systemic Inflammatory Response Syndrome
