[Duodenal perforation due to an endoscopic biliary prosthesis]

Area of Science:

• Gastroenterology
• Surgical Oncology
• Interventional Endoscopy

Background:

• Endoscopic retrograde cholangiopancreatography (ERCP) is a standard procedure for managing malignant biliary obstructions.
• While effective, ERCP carries risks, including pancreatitis, hemorrhage, and the less common complication of duodenal perforation.

Observation:

• This report details two cases of duodenal perforation following biliary prosthesis placement via ERCP in patients with extensive hilar cholangiocarcinoma.
• Symptoms of perforation manifested within hours post-procedure, with diagnosis confirmed by CT scans and laparotomy.

Findings:

• The proposed mechanism for perforation involves proximal adhesion of the biliary prosthesis to the tumor.
• This adhesion intensifies distal trauma from the intraduodenal segment, hindering adaptation to intestinal peristalsis and leading to perforation.

Implications:

• Accurate adjustment of the biliary prosthesis length relative to the biliary stenosis is a critical preventive measure.
• Awareness of this complication and its mechanism can improve patient safety during ERCP for malignant biliary obstruction.