OPTIONS FOR CLOSURE OF RETRO-DUODENAL PERFORATION AFTER ENDOSCOPIC PAPILLOSPHINCTEROTOMY WITH A SELF-EXPENDING STENT

Abstract

Aim. To explore the possibility for a temporary compression of the perforation hole by endobiliary stenting in close proximity of papillotomy anastomosis. Materials and methods. On the basis of clinical observations, two stenting technologies were compared experimentally in case of retro-duodenal perforation development through the pockets of hepaticopancreatic ampulla and in trial cannulation after the pre-scattering: self-expanding endoprosthesis and tight frame stenting with several plastic stents. Results. Closure of the perforation is provided due to a self-expanding stent, when it occurs in 2mm from papillotomy anastomosis. In case of perforation through the pockets of the ampoule of the major duodenal papilla both tight stenting and self-expanding stenting provide a tight closure. Conclusion. In case of retro-duodenal perforation during trial cannulation after the pre-dissection of hepaticopancreatic ampulla, the tight closure of the perforation at a distance of no more than 2 mm. from papillotomy anastomosis is provided by stenting self-expanding endoprosthesis. In case retro-duodenal perforation through the pockets of the ampulla of the Major duodenal papilla occurs, both methods (tight stenting and stenting by a self-expanding stent) ensure tight closure of the perforation.

Keywords

• endoscopic papillosphincterotomy
• retroduodenal perforation
• retroperitoneal space phlegmon prevention
• bile-duct stenting