Clinical course and proposed treatment strategy for ERCP-related duodenal perforation: a multicenter analysis

Young-Joo Jin; Seok Jeong; Jin Hong Kim; Jae Chul Hwang; Byung Moo Yoo; Jong Ho Moon; Sang Heum Park; Ho Gak Kim; Dong Ki Lee; Yong Sun Jeon; Don Haeng Lee

doi:10.1055/s-0033-1344230

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Clinical course and proposed treatment strategy for ERCP-related duodenal perforation: a multicenter analysis

Authors: Young-Joo Jin ; Seok Jeong ; Jin Hong Kim ; Jae Chul Hwang ; Byung Moo Yoo ; Jong Ho Moon ; Sang Heum Park ; Ho Gak Kim ; Dong Ki Lee ; Yong Sun Jeon ; Don Haeng Lee

Citation: ENDOSCOPY, Vol.45(10) : 806-812, 2013

Journal Title: ENDOSCOPY

ISSN: 0013-726X

Issue Date: 2013

MeSH: Aged ; Cholangiopancreatography, Endoscopic Retrograde/adverse effects* ; Duodenal Diseases/diagnosis ; Duodenal Diseases/etiology* ; Duodenal Diseases/mortality ; Duodenal Diseases/therapy ; Female ; Humans ; Intestinal Perforation/diagnosis ; Intestinal Perforation/etiology* ; Intestinal Perforation/mortality ; Intestinal Perforation/therapy ; Kaplan-Meier Estimate ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome

Keywords: Aged ; Cholangiopancreatography, Endoscopic Retrograde/adverse effects* ; Duodenal Diseases/diagnosis ; Duodenal Diseases/etiology* ; Duodenal Diseases/mortality ; Duodenal Diseases/therapy ; Female ; Humans ; Intestinal Perforation/diagnosis ; Intestinal Perforation/etiology* ; Intestinal Perforation/mortality ; Intestinal Perforation/therapy ; Kaplan-Meier Estimate ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome

Abstract: BACKGROUND AND STUDY AIMS:
Endoscopic retrograde cholangiopancreatography (ERCP)-related duodenal perforation is rare but can cause high mortality. Our aim was to assess the clinical outcomes of these events.
METHOD:
A total of 59 patients who were diagnosed as having ERCP-related duodenal perforation at six institutions between 2000 and 2007 were enrolled in this multicenter retrospective study. We evaluated complications and mortality associated with ERCP-related duodenal perforation according to injury detection time (IDT), peritoneal irritation signs (PIS), systemic inflammation signs (SIS), and treatment modality in these patients.
RESULTS:
Of the 59 patients, 41 (69.5 %) and 18 (30.5 %) underwent medical and surgical treatment, respectively. Duodenal perforation-related death was observed in five patients, who had received medical therapy (n = 2) and surgical therapy (n = 3). Among medically treated patients, seven patients (17.1 %) underwent endoscopic clipping immediately after the injury; surgery was not required as a salvage therapy and there were no complications or deaths among these patients. The remaining 34 patients received antibiotics combined with therapeutic fasting and intravenous hydration. Duodenal perforation-related complications depended significantly on IDT (P = 0.0001), treatment modality (P = 0.008), PIS (P = 0.003), and SIS (P = 0.010). The duodenal perforation-related mortality was significantly related to IDT (P = 0.008) and PIS (P = 0.001).
CONCLUSIONS:
IDT, PIS, and SIS appear to be important prognostic factors following ERCP-related duodenal perforation. Medical therapy can be suggested as an initial treatment strategy for ERCP-related duodenal perforation, and if possible, endoscopic clipping is strongly recommended. However, surgical treatment should be considered if the perforation is not expected to seal spontaneously, or if the continuing leakage causes PIS or SIS.