Τίτλος:
A Tailored Approach to the Management of Perforations Following Endoscopic Retrograde Cholangiopancreatography and Sphincterotomy
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
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.
Συγγραφείς:
Polydorou, A.
Vezakis, A.
Fragulidis, G.
Katsarelias, D.
Vagianos, C.
Polymeneas, G.
Περιοδικό:
Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Λέξεις-κλειδιά:
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
DOI:
10.1007/s11605-011-1723-3
