Objective To evaluate the causes, diagnostic and therapeutic principles, and prevention of the perforation related to endoscopic retrograde cholangiopancreatography (ERCP) . Methods All patients who developed perforation after ERCP in the Central Hospital of Shanghai Jiading District from January 2009 to December 2013 were recruited. The causes, types, and diagnosis and treatment of perforation were analyzed retrospectively. Results ERCP was done in 459 cases during the 4 years, and 6 (1. 3%) of them developed perforation.The causes of perforation were as follows: endoscope insertion (3 cases) , catheterization or sphincterotomy (2 cases) , and guide wire or Dormia basket (1 case) . Two cases received conservative management successfully and were discharged; four cases underwent surgical treatment, and one of them died. Conclusion Patients with ERCP-related perforation can achieve ideal prognosis through individualized treatment based on the causes and types of perforation. Careful and cautious operation, especially for the elderly or the patients with a history of upper abdominal operation, will reduce the incidence of ERCP-related perforation.
[1]FREEMAN ML, NELSON DB, SHERMAN S, et al.Complications of endoscopic biliary sphincterotomy[J].N Engl J Med, 1996, 335 (13) :909-918.
|
[2]LOPERFIDO S, ANGELINI G, BENEDETTI G, et al.Major early complications from diagnostic and therapeutic ERCP:a prospective multicenter study[J].Gastrointest Endosc, 1998, 48 (1) :1-10.
|
[3]COTTON PB, LEHMAN G, VENNES J, et al.Endoscopic sphincterotomy complications and their management:an attempt at consensus[J].Gastrointest Endosc, 1991, 37 (3) :383-393.
|
[4]MASCI E, TOTI G, MARIANI A, et al.Complications of diagnostic and therapeutic ERCP:a prospective multicenter study[J].Am J Gastroenterol, 2001, 96 (2) :417-423.
|
[5]HOWARD TJ, TAN T, LEHMAN GA, et al.Classification and management of perforations complicating endoscopic sphincterotomy[J].Surgery, 1999, 126 (4) :658-663.
|
[6]STAPFER M, SELBY RR, STAIN SC, et al.Management of duodenal perforation after endoscopic retrograde cholangiopancreatography and sphincterotomy[J].Ann Surg, 2000, 232 (1) :191-198.
|
[7]ENNS R, ELOUBEIDI MA, MERGENER K, et al.ERCP-related perforations:risk factors and management[J].Endoscopy, 2002, 34 (4) :293-298.
|
[8]BOOTH FV, DOERR RJ, KHALAFI RS, et al.Surgical management of complications of endoscopic sphincterotomy with precut papillotomy[J].Am J Surg, 1990, 159 (1) :132-135.
|
[9]BYUNG SK, IN-GYU K, BYOUNG YR, et al.Management of endoscopic retrograde cholangiopancreatography-related perforations[J].J Korean Surg Soc, 2011, 81 (3) :195-204.
|
[10]KAYHAN B, AKDOGˇAN M, SAHIN B.ERCP subsequent to retroperitoneal perforation caused by endoscopic sphincterotomy[J].Gastrointest Endosc, 2004, 60 (5) :833-835.
|
[11]SEIBERT DG.Use of an endoscopic clipping device to repair a duodenal perforation[J].Endoscopy, 2003, 35 (5) :189.
|
[12]MUTIGNANI M, IACOPINI F, DOKAS S, et al.Successful endoscopic closure of a lateral duodenal perforation at ERCP with fibrin glue[J].Gastrointest Endosc, 2006, 63 (4) :725-727.
|
[13]CHUNG RS, SIVAK MV, FERGUSON DR.Surgical decisions in the management of duodenal perforation complicating endoscopic sphincterotomy[J].Am J Surg, 1993, 165 (6) :700-703.
|
[14]SARLI L, PORRINI C, COSTI R, et al.Operative treatment of periampullary retroperitoneal perforation complicating endoscopic sphincterotomy[J].Surgery, 2007, 142 (1) :26-32.
|
[15]AVGERINOS DV, LLAGUNA OH, LO AY, et al.Management of endoscopic retrograde cholangiopancreatography:related duodenal perforations[J].Surg Endosc, 2009, 23 (4) :833-838.
|