Repair of an EUS--induced duodenal perforation with endoscopic clips

Endoscopic ultrasound (EUS) is considered a safe procedure; however, rare deaths have been reported due to complications such as perforation of the gastrointestinal tract. Several factors including age, the presence or absence of cervical osteophytes or duodenal diverticula, history of difficult intubation with prior endoscopic procedure, endosonographer's inexperience, or EUS guided interventions such as the drainage of the pancreatic duct or pseudocyst and fine needle aspiration may increase the risk of EUS related perforation of the gastrointestinal tract. We report a patient with pancreatic mass who developed duodenal perforation during EUS and was treated successfully with an immediate closure of perforation using endoscopic clips combined with bowel rest and antibiotics. Based on our patient and others reported in the literature, immediate recognition and closure of perforation with endoscopic clips may be useful in the management of patients with EUS induced duodenal perforation. However, surgical consultation and close clinical monitoring is required in the management of these patients.