Clin Endosc.  2017 Mar;50(2):202-205. 10.5946/ce.2016.112.

Repair of an Endoscopic Retrograde Cholangiopancreatography-Related Large Duodenal Perforation Using Double Endoscopic Band Ligation and Endoclipping

Affiliations
  • 1Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea. smpark@chungbuk.ac.kr

Abstract

Endoscopic closure techniques have been introduced for the repair of duodenal wall perforations that occur during endoscopic retrograde cholangiopancreatography (ERCP). We report a case of successful repair of a large duodenal wall perforation by using double endoscopic band ligation (EBL) and an endoclip. Lateral duodenal wall perforation occurred during ERCP in a 93-year-old woman with acute calculous cholangitis. We switched to a forward endoscope that had a transparent band apparatus. A 2.0-cm oval-shaped perforation was found at the lateral duodenal wall. We repaired the perforation by sequentially performing double EBL and endoclipping. The first EBL was performed at the proximal edge of the perforation orifice, and two-thirds of the perforation were repaired. The second EBL, which also included the contents covered under the first EBL, repaired the defect almost completely. Finally, to account for the possible presence of a residual perforation, an endoclip was applied at the distal end of the perforation. The detection and closure of the perforation were completed within 10 minutes. We suggest that double EBL is an effective method for closure.

Keyword

Cholangiopancreatography, endoscopic retrograde; Duodenal perforation; Endoscopic band ligation

MeSH Terms

Cholangiopancreatography, Endoscopic Retrograde
Cholangitis
Endoscopes
Female
Humans
Ligation*
Methods

Figure

  • Fig. 1. Gastroscopic findings of duodenal wall perforation during endoscopic retrograde cholangiopancreatography and closure with double band ligation and endoclipping. (A) Duodenal wall perforation caused by insertion of the lateral scope into the second portion of the duodenum. The peritoneal contents were visible through the 2.0-cm perforation. (B) Partial closure of the duodenal perforation via the first band ligation. (C) Closure of the duodenal perforation including the duodenal wall and peritoneal fat with double band ligation. (D) Complete closure of the duodenal perforation with endoclipping after double band ligation. (E) Diagrammatic representation of the band ligation and endoclipping procedures for the repair of large duodenal perforations.

  • Fig. 2. Simple abdomen after the endoscopic closure procedure. No retroperitoneal air leakage was observed near the right kidney.

  • Fig. 3. The flow chart of the patient’s vital signs. The vital signs remained within the normal range during the hospital stay after the patient underwent duodenal closure with band ligation and endoclipping. (A) At the day 1 and day 2, fever were noticed. (B) Blood pressures and heart rates were within normal ranges during whole hospital days.


Reference

1. Van Stiegmann G, Goff JS. Endoscopic esophageal varix ligation: preliminary clinical experience. Gastrointest Endosc. 1988; 34:113–117.
Article
2. Han JH, Lee TH, Jung Y, et al. Rescue endoscopic band ligation of iatrogenic gastric perforations following failed endoclip closure. World J Gastroenterol. 2013; 19:955–959.
Article
3. Gupta S, Kaushik R, Sharma R, Attri A. The management of large perforations of duodenal ulcers. BMC Surg. 2005; 5:15.
Article
4. Fan CS, Soon MS. Repair of a polypectomy-induced duodenal perforation with a combination of hemoclip and band ligation. Gastrointest Endosc. 2007; 66:203–205.
Article
5. Stapfer M, Selby RR, Stain SC, et al. Management of duodenal perforation after endoscopic retrograde cholangiopancreatography and sphincterotomy. Ann Surg. 2000; 232:191–198.
Article
6. Alfieri S, Rosa F, Cina C, et al. Management of duodeno-pancreato-biliary perforations after ERCP: outcomes from an Italian tertiary referral center. Surg Endosc. 2013; 27:2005–2012.
Article
7. Mutignani M, Iacopini F, Dokas S, et al. Successful endoscopic closure of a lateral duodenal perforation at ERCP with fibrin glue. Gastrointest Endosc. 2006; 63:725–727.
Article
8. Nakagawa Y, Nagai T, Soma W, et al. Endoscopic closure of a large ERCP-related lateral duodenal perforation by using endoloops and endoclips. Gastrointest Endosc. 2010; 72:216–217.
Article
9. Katsinelos P, Paroutoglou G, Papaziogas B, Beltsis A, Dimiropoulos S, Atmatzidis K. Treatment of a duodenal perforation secondary to an endoscopic sphincterotomy with clips. World J Gastroenterol. 2005; 11:6232–6234.
Article
10. Lee TH, Bang BW, Jeong JI, et al. Primary endoscopic approximation suture under cap-assisted endoscopy of an ERCP-induced duodenal perforation. World J Gastroenterol. 2010; 16:2305–2310.
Article
11. Buffoli F, Grassia R, Iiritano E, Bianchi G, Dizioli P, Staiano T. Endoscopic “retroperitoneal fatpexy” of a large ERCP-related jejunal perforation by using a new over-the-scope clip device in Billroth II anatomy (with video). Gastrointest Endosc. 2012; 75:1115–1117.
Article
12. Law R, Deters JL, Miller CA, Marler RJ, Baron TH. Endoscopic band ligation for closure of GI perforations in a porcine animal model (with video). Gastrointest Endosc. 2014; 80:717–722.
Article
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