Management and Clinical Outcomes of Iatrogenic Injury Secondary to Endoscopic Retrograde Cholangiopancreatography

Abstract

Introduction:Perforation secondary to endoscopic retrograde cholangiopancreatography (ERCP) is a rare complication but a problematic one because of associated morbidity and mortality. In our study, we aimed to define correct timing for surgery, to analyze and present our results on suitable methods that can be used in the surgical management of perforation secondary to ERCP done for various indications.Methods:The data were collected from 19 patients who underwent surgery for perforation secondary to ERCP. We retrospectively analyzed clinical and demographic characteristics with the treatment outcomes of these patients.Results:The mean age of the patients was 57 years (range: 16-92). The ERCP procedure was for therapeutic purposes in all the patients. Perforation mostly occurred during sphincterectomy, as was seen in 12 patients (63%). The patients underwent surgical intervention at a mean of 42.5 hours (range: 3-192) after perforation. Postoperative mortality occurred in seven patients (36.8%). The mean hospitalization period was 16.5 days (range: 11-49).Conclusion:Duodenal perforation is an ERCP-related complication that carries high mortality and morbidity risks, even in experienced tertiary centers. When perforation is suspected, these patients should immediately be referred to experienced centers/units for further management. Careful scrutiny of clinical and radiological findings is critical in choosing the appropriate surgical intervention.

Keywords

• endoscopic retrograde cholangiopancreatography
• perforation
• surgical treatment