Parenchymal Guidewire Perforation during ERCP: An Unappreciated Injury

Area of Science:

• Gastroenterology
• Surgical Complications
• Endoscopic Retrograde Cholangiopancreatography (ERCP)

Background:

• ERCP is associated with known complications, but less appreciated risks exist.
• Guidewire manipulation can cause iatrogenic injury to the pancreatic or hepatic parenchyma.
• These injuries are often preventable.

Purpose of the Study:

• To report on the clinical course of patients experiencing guidewire injury during ERCP.
• To emphasize the diagnostic challenges and management strategies for these rare complications.
• To highlight the potential for conservative or minimally invasive treatment.

Main Methods:

• Case series presentation of three patients with suspected guidewire injury post-ERCP.
• Clinical assessment, diagnostic workup, and treatment interventions were reviewed.
• Management approaches ranged from conservative care to surgical intervention.

Main Results:

• One patient with pancreatic parenchyma perforation successfully managed conservatively.
• Two patients with hepatic parenchyma injury required emergency surgery with intraperitoneal drainage.
• All patients experienced successful outcomes, avoiding more invasive procedures.

Conclusions:

• Guidewire perforation of the pancreatic or hepatic parenchyma is an under-recognized ERCP complication.
• Prompt diagnosis and appropriate management, including conservative or minimally invasive options, can lead to favorable outcomes.
• Awareness and careful technique during ERCP can prevent such injuries.