Clin Endosc.  2014 Jul;47(4):341-345. 10.5946/ce.2014.47.4.341.

The Management of Endoscopic Retrograde Cholangiopancreatography-Related Duodenal Perforation

• Cho KB

• KMID: 1907935
• DOI: http://doi.org/10.5946/ce.2014.47.4.341

Abstract

Uneventful duodenal perforation during endoscopic retrograde cholangiopancreatography (ERCP) is an uncommon but occasionally fatal complication. ERCP-related perforations may occur during sphincterotomy and improper manipulation of the equipment and scope. Traditionally, duodenal perforation has been treated with early surgical repair. Recently, nonoperative early endoscopic management techniques including clips or fibrin glue have been reported. In the present paper we review the literature pertaining to the treatment of perforations.

Keyword

Cholangiopancreatography, endoscopic retrograde; Perforation; Stents

MeSH Terms

Cholangiopancreatography, Endoscopic Retrograde
Fibrin Tissue Adhesive
Stents
Fibrin Tissue Adhesive

Figure

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  Fig. 1 Classification of iatrogenic duodenal perforations: type I, duodenal perforation due to endoscopy; type II, sphincterotomy-related perforation; type III, biliary perforations due to endoscopic instruments such as guidewires; type IV, microperforations at the retroperitoneum during endoscopy. Adapted from Lee et al. Clin Endosc 2013;46:522-528.9

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  Fig. 2 Free air collection in the retroperitoneum after endoscopic sphincterotomy.

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  Fig. 3 Primary endoscopic closure of a duodenal wall perforation using endoclips. (A) Image obtained using a cap-assisted endoscope showing an ovoid perforation. (B) The perforation site was managed successfully using endoclips.

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  Fig. 4 Abdominal computed tomography scan showing fluid and air collection in the right retroperitoneum. To block further bile and pancreatic juice leakage, a self-expandable stent (arrow) was inserted at the distal common bile duct as conservative treatment.

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