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ERCP-Related Perforations

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Endotherapy in Biliopancreatic Diseases: ERCP Meets EUS

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Abstract

Perforations are threatening adverse events during ERCP, with an incidence ranging between 0.08 and 2.2% of the procedures, varying among the different series. ERCP-related perforations are divided into four groups according to Stapfer’s classification: type 1 (duodenal wall), type 2 (periampullary), type 3 (biliary duct), and type 4 (only free air at the CT scan). Many risk factors (RF) have been reported for ERCP-related perforations; most important RFs are surgically altered anatomy, for type 1, and sphincterotomy, use of guidewires, and biliary or papillary dilation, for type 2 and 3. The immediate recognition of the perforation at the endoscopy or at the fluoroscopy is crucial to achieve better outcomes and for a timely treatment. Post-procedural diagnosis of perforation is usually, clinically suspected, and subsequently confirmed by abdominal CT scan. A prompt endoscopic closure of type 1 perforation should be attempted; otherwise surgery is strongly recommended. In type 2 and 3 perforations, conservative management is appropriate, although the endoscopic immediate placement of FCSEMS seems to be indicated to achieve better outcomes and to avoid subsequent surgery with prolonged hospital stay and high morbidity and mortality.

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Abbreviations

ABX:

Antibiotics

BS:

Biliary stent

C:

Conservative treatment

CBD:

Common bile duct

CR:

Case report

CS:

Case series

CT:

Computed tomography

E:

Endoscopy

EBL:

Endoscopic band ligation

ERCP:

Endoscopic retrograde cholangiopancreatography

FCSEMS:

Fully covered self-expandable metal stent

IV:

Intravenous

NBD:

Naso-biliary drainage

NBM:

Nil-by-mouth

NDT:

Naso-duodenal tube

NGT:

Nasogastric tube

NNR:

Number not reported

NR:

Not reported

OTSC:

Over-the-scope clip

PBS:

Plastic biliary stent

PCD:

Percutaneous drainage (surgical)

PTC:

Percutaneous transhepatic cholangiography

R:

Retrospective

S:

Surgery

TTSC:

Through-the-scope clip

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Authors and Affiliations

  1. Endoscopy Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

    Alberto Tringali

  2. ULSS 2 Marca Trevigiana, Conegliano Hospital, Conegliano, Italy

    Alberto Tringali

  3. Endoscopy Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

    Marcello Cintolo & Massimiliano Mutignani

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  1. Alberto Tringali
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  2. Marcello Cintolo
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  3. Massimiliano Mutignani
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Correspondence to Alberto Tringali .

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Editors and Affiliations

  1. Digestive and Interventional Endoscopy Unit, Grande Ospedale Metropolitano Niguarda, Piazza dell’Ospedale Maggiore, Milano, Italy

    Massimiliano Mutignani

  2. Hepatologie und Endokrinologie, Abteilung für Gastroenterologie, Robert-Bosch-Krankenhaus, Auerbachstraße, Stuttgart, Germany

    Jörg G. Albert

  3. Department of Gastroenterology, Azienda USL di Forlì-Cesena, Bologna, Italy

    Carlo Fabbri

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Tringali, A., Cintolo, M., Mutignani, M. (2020). ERCP-Related Perforations. In: Mutignani, M., Albert, J.G., Fabbri, C. (eds) Endotherapy in Biliopancreatic Diseases: ERCP Meets EUS. Springer, Cham. https://doi.org/10.1007/978-3-030-42569-2_33

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