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Management of duodeno-pancreato-biliary perforations after ERCP: outcomes from an Italian tertiary referral center

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An Erratum to this article was published on 19 April 2013

Abstract

Background

The management of post-endoscopic retrograde cholangiopancreatography (ERCP) perforation is often unknown by many physicians, and there is a paucity of literature regarding the best surgical management approach.

Patients and methods

A retrospective review of ERCP-related perforations to the duodeno-pancreato-biliary tract observed at the Digestive Surgery Department of the Catholic University of Rome was conducted to identify their optimal management and clinical outcome.

Results

From January 1999 to December 2011, 30 perforations after ERCP were observed. Seven patients underwent ERCP at another institution, and 23 patients underwent an endoscopic procedure at our hospital. Diagnosis of perforation was both clinical and instrumental. Fifteen patients (50 %) were successfully treated conservatively. Fifteen patients (50 %) underwent surgery after a mean time of 8.1 days (range 1–26 days) from ERCP: ten received a retroperitoneal laparostomy approach, three of them both an anterior and posterior laparostomy approach, and two an anterior laparostomy approach. Duodenal leak closure was observed after a mean (±standard deviation, SD) of 12.6 (±4.6) and 24.6 (±7.9) days after conservative and surgical treatment, respectively (p < 0.001). The overall and postoperative mortality rates were 13.3 % (4 of 30 patients) and 26.6 % (4 of 15 patients), respectively.

Conclusions

Post-ERCP perforation is burdened by a high risk of mortality. Early clinical and radiographic features have to be used to determine which type of surgical or conservative treatment is indicated. Half of patients can be treated conservatively, but in case of sepsis or unstable general conditions, early surgical procedure is indicated as the only possible chance of recovery.

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Disclosures

Drs. Sergio Alfieri, Fausto Rosa, Caterina Cina, Antonio Pio Tortorelli, Andrea Tringali, Vincenzo Perri, Guido Costamagna, and Giovanni Battista Doglietto have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Digestive Surgery Department, Catholic University, “A. Gemelli” Hospital, Largo A. Gemelli, 8, 00168, Rome, Italy

    Sergio Alfieri, Fausto Rosa, Caterina Cina, Antonio Pio Tortorelli & Giovanni Battista Doglietto

  2. Digestive Endoscopy Department, Catholic University, “A. Gemelli” Hospital, Rome, Italy

    Andrea Tringali, Vincenzo Perri & Guido Costamagna

Authors
  1. Sergio Alfieri
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  2. Fausto Rosa
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  3. Caterina Cina
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  4. Antonio Pio Tortorelli
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  5. Andrea Tringali
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  6. Vincenzo Perri
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  7. Guido Costamagna
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  8. Giovanni Battista Doglietto
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Correspondence to Fausto Rosa.

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Alfieri, S., Rosa, F., Cina, C. et al. Management of duodeno-pancreato-biliary perforations after ERCP: outcomes from an Italian tertiary referral center. Surg Endosc 27, 2005–2012 (2013). https://doi.org/10.1007/s00464-012-2702-9

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  • DOI: https://doi.org/10.1007/s00464-012-2702-9

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