J Korean Surg Soc.  2011 Sep;81(3):195-204. 10.4174/jkss.2011.81.3.195.

Management of endoscopic retrograde cholangiopancreatography-related perforations

• Kim BS
• Kim IG
• Ryu BY
• Kim JH
• Yoo KS
• Baik GH
• Kim JB
• Jeon JY

• KMID: 2212197
• DOI: http://doi.org/10.4174/jkss.2011.81.3.195

Abstract

PURPOSE
The purpose of this study is to analyze the treatment strategies of patients with endoscopic retrograde cholangiopancreatography (ERCP)-related perforations. This is a retrospective study.
METHODS
We experienced 13 perforations associated with ERCP. We reviewed the medical recordsand classified ERCP-related perforations according to mechanism of injury in terms of perforating device. Injury by endoscopic tip or insertion tube was classified as type I, injury by cannulation catheter or sphincterotomy knife as type II, and injury by guidewire as type III.
RESULTS
Of four type I injuries, one case was managed by conservative management after primary closure with a hemoclip during ERCP. The other three patients underwent surgical treatments such as primary closure orpancreatico-duodenectomy. Of five type II injuries, two patients underwent conservative management and the other three cases were managed by surgical treatment such as duodenojejunostomy, duodenal diverticulization and pancreatico-duodenectomy. Of four type III injuries, three patients were managed conservatively and the remaining patient was managed by T-tube choledochostomy.
CONCLUSION
Type I injuries require immediate surgical management after EPCP or immediate endoscopic closure during ERCP whenever possible. Type II injuries require surgical or conservative treatment according to intra- and retro-peritoneal dirty fluid collection findings following radiologic evaluation. Type III injuries almost always improve after conservative treatment with endoscopic nasobilliary drainage.

Keyword

Endoscopic retrograde cholangiopancreatography; Perforation; Surgery

MeSH Terms

Catheterization
Catheters
Cholangiopancreatography, Endoscopic Retrograde
Drainage
Humans
Retrospective Studies

Figure

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  Fig. 1 Classification of endoscopic retrograde cholangiopancreatography-related perforations according to injury mechanism.

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  Fig. 2 Algorithm for the management of endoscopic retrograde cholangiopancreatography-related perforations. CT, computed tomography.

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