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. 2018 Dec;32(12):4841-4849.
doi: 10.1007/s00464-018-6235-8. Epub 2018 May 16.

The importance of early recognition in management of ERCP-related perforations

Jason G Bill  1 , Zachary Smith  2   3 , Joseph Brancheck  2 , Jeffrey Elsner  2 , Paul Hobbs  2 , Gabriel D Lang  2 , Dayna S Early  2 , Koushik Das  2 , Thomas Hollander  2 , Maria B Majella Doyle  4 , Ryan C Fields  4 , William G Hawkins  4 , Steven M Strasberg  4 , Chet Hammill  4 , William C Chapman  4 , Steven Edmundowicz  5 , Daniel K Mullady  2 , Vladimir M Kushnir  2
Affiliations

The importance of early recognition in management of ERCP-related perforations

Jason G Bill et al. Surg Endosc. 2018 Dec.

Abstract

Background: Iatrogenic perforations related to endoscopic retrograde cholangiopancreatography (ERCP) are rare events, carrying with it a mortality of up to 8%. Given the rarity of this adverse event, there remains limited data and continued uncertainties when choosing therapeutic strategies. Our aims were to evaluate the management of ERCP-related perforations and compare outcomes based on timing of recognition.

Methods: The endoscopic databases of two tertiary care centers were interrogated to identify consecutive adult patients who sustained ERCP-related perforation over a 10-year period from 2006 to 2016. Electronic medical records were reviewed to extract demographic data, perforation type, management strategies, clinical data, and patient outcomes.

Results: 14,045 ERCP's were performed during our 10-year study period. Sixty-three patients (average age 62.3 ± 2.38 years, 76% female) with ERCP-related perforations were included. Stapfer I perforations were found in 14 (22.2%) patients, Stapfer II in 24 (38.1%), and Stapfer III and IV perforations were identified in 16 (25.4%) and 9 (14.28%), respectively. Forty-seven (74.6%) perforations were recognized immediately during the ERCP, whereas 16 (25.4%) were recognized late. Endoscopic therapy was attempted in 35 patients in whom perforations were identified immediately, and was technically successful in 33 (94.3%). In all, 4 (1 immediate/ 3 delayed) patients required percutaneous drainage and 9 (5 immediate/ 4 delayed) surgery. Length of hospital stay, ICU admission were significantly shorter and incidence of SIRS was significantly lower when perforation was recognized immediately.

Conclusions: Immediate recognition of ERCP-related perforations leads to more favorable patient outcomes; with lower incidence of SIRS, less need for ICU level care, and shorter hospital stay.

Keywords: Endoscopic retrograde cholangiopancreatography; Iatrogenic perforation.

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