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ERCP-Related Perforations

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Dilemmas in ERCP


Iatrogenic perforations related to endoscopic retrograde cholangiopancreatography (ERCP) are an uncommon adverse event, occurring in 0.14–1.3% of cases, and are associated with a mortality of up to 8%. The most widely utilized classification system was proposed by Stapfer et al. and characterizes perforations based on mechanism and location. Type I perforations occur on the lateral duodenal wall secondary to endoscope trauma, type II are sphincterotomy-related, type III are perforations of the bile duct or pancreatic duct with endoscopic tools, and type IV are miniscule and identified with free air on fluoroscopic imaging. Studies utilizing this classification system demonstrate that patients with type III and IV perforations do well with conservative management alone, whereas patients with type I and II perforations frequently require surgical management and are more likely to have poor outcomes. There remain many unanswered questions pertaining to the exact role of surgical, endoscopic, and medical therapy, especially in patients with type I, II, and III perforations. In this chapter we will focus on perforation related to ERCP, outlining a diagnostic and management strategy as it pertains to classification, and emphasize a management algorithm that can be used to better approach this serious adverse event.

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Correspondence to Vladimir M. Kushnir .

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Bill, J.G., Kushnir, V.M. (2019). ERCP-Related Perforations. In: Mullady, D. (eds) Dilemmas in ERCP. Springer, Cham.

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  • Print ISBN: 978-3-030-12740-4

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