TY - JOUR
TI - A Tailored Approach to the Management of Perforations Following Endoscopic Retrograde Cholangiopancreatography and Sphincterotomy
AU - Polydorou, A.
AU - Vezakis, A.
AU - Fragulidis, G.
AU - Katsarelias, D.
AU - Vagianos, C.
AU - Polymeneas, G.
JO - Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
PY - 2011
VL - 15
TODO - 12
SP - 2211-2217
PB - 
SN - 1091-255X, 1873-4626
TODO - 10.1007/s11605-011-1723-3
TODO - adult;  aged;  article;  duodenum;  endoscopic retrograde cholangiopancreatography;  endoscopic sphincterotomy;  female;  Greece;  human;  intestine perforation;  length of stay;  male;  middle aged;  pathology;  postoperative complication;  radiography;  retrospective study;  treatment outcome, Adult;  Aged;  Aged, 80 and over;  Cholangiopancreatography, Endoscopic Retrograde;  Duodenum;  Female;  Greece;  Humans;  Intestinal Perforation;  Length of Stay;  Male;  Middle Aged;  Postoperative Complications;  Retrospective Studies;  Sphincterotomy, Endoscopic;  Treatment Outcome
TODO - Background: The management of endoscopic retrograde cholangiopancreatography (ERCP)-related perforations remains controversial. The aim of the study was to determine the incidence of perforations following ERCP, their characteristics, operative and non-operative management options and clinical outcome. Methods: A retrospective review of ERCP-related perforations, during a 21-year period, was performed. Each perforation was categorized into types I to IV according to the location, mechanism and radiographic evaluation of the injury. Comparisons were made between patients treated operatively and non-operatively. Results: Forty-four perforations (0. 4%) occurred in 9,880 procedures. They were mainly caused by the passage of the endoscope (type I) in 7 (16%) and sphincterotomy (type II) in 30 (68%) patients. The management was non-operative in 32 (72%) and operative in 12 patients. In multivariate analysis, only the type of perforation (type I: endoscope-related) was found significant for predicting operative treatment. The hospital stay was longer for patients requiring an operation (median, 24 vs 9 days). The overall mortality was 2/44 (4. 5%). There was no death in the non-operative group. Conclusions: The need for immediate operative intervention should be based on the type of injury and clinical findings. Patients with type I perforations should be treated surgically and primary repair should be tried. Patients with type II injuries may be treated initially non-operatively. Delayed operative intervention will be required in a minority of these patients. © 2011 The Society for Surgery of the Alimentary Tract.
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