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Published on: January 7, 2019
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Management of ERCP-related perforation: a large multicenter study
Tomoya Emori1, Tomoaki Yamasaki2, Masahiro Itonaga3
1Department of Gastroenterology, Wakayama Rosai Hospital, Wakayama, Japan.
Gastrointestinal Endoscopy
|December 17, 2024
Summary
Endoscopic retrograde cholangiopancreatography (ERCP) related duodenal perforations are rare but serious. Early endoscopic diagnosis and treatment significantly reduce length of stay and improve outcomes compared to surgery.
Area of Science:
- Gastroenterology and Endoscopy
- Surgical Adverse Events
- Medical Device Complications
Background:
- Perforation is a rare but serious complication of Endoscopic Retrograde Cholangiopancreatography (ERCP).
- Lack of consensus exists regarding optimal management (surgical vs. endoscopic) for ERCP-related duodenal perforations.
- This study investigates characteristics and outcomes of duodenal perforations based on injury mechanism.
Purpose of the Study:
- To evaluate the incidence and outcomes of ERCP-related duodenal perforations.
- To compare clinical outcomes based on the mechanism of injury, diagnosis timing, and treatment modality.
- To determine the optimal management strategy for ERCP-induced duodenal perforations.
Main Methods:
- Retrospective analysis of 51,957 patients undergoing ERCP across 21 tertiary care hospitals in Japan (April 2017-March 2022).
- Classification of duodenal perforations using the Stapfer system.
- Evaluation of serious adverse events, length of stay (LOS), and mortality.
Main Results:
- 58 (0.12%) patients experienced ERCP-related duodenal perforations.
- Mean LOS was 27.1 days with a 2% mortality rate.
- Endoscopic treatment was associated with significantly shorter LOS and time to healing compared to surgical treatment. Intraprocedural diagnosis was also linked to better outcomes.
Conclusions:
- Intraprocedural diagnosis of perforation during ERCP is crucial for preventing severe adverse events.
- Careful review of fluoroscopic and endoscopic imaging is recommended.
- Endoscopic management should be prioritized for patients diagnosed with ERCP-related duodenal perforations during the procedure.
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