Management of ERCP-related perforation: a large multicenter study

Abstract

Background and aims: Perforation is a rare but serious adverse event associated with ERCP. There is no consensus to guide clinicians in the management of ERCP-related duodenal perforations, making it difficult to determine whether surgical or endoscopic treatment is optimal. The present study retrospectively evaluated the characteristics and clinical outcomes of patients who experienced ERCP-related duodenal perforations according to the mechanism of injury.

Methods: This study evaluated the incidence of ERCP-related duodenal perforations among 51,957 patients who underwent ERCP at 21 tertiary care hospitals in Japan between April 2017 and March 2022. ERCP-related duodenal perforations were categorized according to the Stapfer classification system. Serious adverse events, length of stay (LOS), and mortality associated with ERCP-related duodenal perforations were evaluated according to the mechanism of injury, time of diagnosis, and treatment modality.

Results: Of 51,957 patients who underwent ERCP, 58 (.12%) experienced ERCP-related duodenal perforations. The mean LOS was 27.1 days, and the mortality rate was 2%. LOS (P = .031) and time to healing (P = .009) were significantly shorter in patients who underwent endoscopic than surgical treatment. Multivariate Cox regression analysis showed that endoscopic treatment (P = .017) and intraprocedural diagnosis (P = .019) were independently associated with a good clinical course.

Conclusions: Diagnosing a perforation during the ERCP procedure can prevent serious adverse events. Fluoroscopic and endoscopic images should be carefully reviewed. Endoscopic management should be the treatment of choice for patients diagnosed with perforation during ERCP procedures.