Value of temporary stents for the management of perivaterian perforation during endoscopic retrograde cholangiopancreatography

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) has become the mainstay of treatment in hepato-pancreato-biliary disease. However, ERCP requires a high level of technical skills and experience in therapeutic endoscopy, there is always a risk of complications. Especially, the perforation per se affects the patient adversely, and the clinical course may lead to a poor prognosis, even with appropriate management. The treatments for ERCP-related perforation are diverse, depending on the location and mechanism of the bowel perforation and the time of diagnosis. Thus, we reviewed the appropriate surgical and non-surgical management options for therapeutic ERCP-related perforations, especially, evaluating metallic stenting as a treatment modality in perivaterian perforation.

Keywords: Duodenum; Endoscopic retrograde cholangiopancreatography; Perforation; Perivaterian; Self-expandable metallic stent.

Figure 1

Insertion of fully covered self-expandable metallic stent for the management of periampullary perforation immediately after endoscopic sphincterotomy. A: A peri-ampullary perforation was seen after endoscopic sphincterotomy; B: A fully covered self-expandable metallic stent (5-cm-long, 10 mm in diameter) inserted into the common bile duct to prevent bile entering the perforation site can be seen at the ampulla of vater.

Figure 2

Deployed fully covered self-expandable metallic stent on (A) abdominal X-ray and (B) abdominal computed tomography scan.