Duodenal perforations after endoscopic retrograde cholangiopancreatography (ERCP) are an uncommon complication. The management of this kind of. ERCP-related duodenal perforation can be a severe complication with related mortality. Early diagnosis of post-ERCP perforations is essential. Duodenal perforation is an uncommon complication of endoscopic retrograde Of the other four, one died after initial laparotomy. – were searched for cases of duodenal perforation following endoscopy or ERCP.


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Abstract Background and Aim.


Perforation after endoscopic retrograde cholangiopancreatography ERCP is a rare complication, but it is associated with significant mortality. This study evaluated the early management experience of these perforations.

Nine of these 16 patients with perforations were periampullary, 3 duodenal, 1 gastric fundus, and post ercp duodenal perforation patients had a perforation of an afferent limb of a Billroth II anastomosis.

One patient with duodenal perforation and three patients with afferent limb perforation received surgery, others received medical conservative treatment which included suturing lesion, endoscopic nasobiliary drainage ENBDendoscopic retrograde pancreatic duct drainage ERPDgastrointestinal decompression, fasting, broad-spectrum antibiotics, and so post ercp duodenal perforation.

All patients with perforation recovered successfully.

Introduction Perforations related with endoscopic retrograde cholangiopancreatography ERCP are rare but serious complications.

Its incidence has been reported by recent studies ranging from 0. Many patients with ERCP-related perforations recovered by surgery or by post ercp duodenal perforation therapy [ 2 — 6 ].

Gastroenterology Research and Practice

However, we do not know which patients require surgery, and when these patients should receive surgery. In this study we evaluate our experience for early management of ERCP-related perforations at our endoscopy centre.

We looked retrospectively up all the cases in this period. A total of 16 perforations 0. Patient demographics including age, sex, and comorbidities such as coronary heart disease CHDchronic obstructive pulmonary disease COPDchronic post ercp duodenal perforation failure, and malignancy were noted.

The indication for ERCP, clinical presentation, management, and length of post ercp duodenal perforation in hospital were also recorded and analyzed.

Results Sixteen perforations were identified. These included 1 fundus perforation intraperitoneal perforation3 afferent limb perforations intra-peritoneal perforation3 lateral wall of duodenal perforations intra-peritoneal perforationand 9 periampullaris perforations retroperitoneal perforations.

If we classifed the perforations as retroperitoneal perforations and peritoneal perforations, nine of them were retroperitoneal perforations, and the other seven were peritoneal perforations.

Of the nine patients post ercp duodenal perforation retroperitoneal perforations, 5 resulted from papillotomy, 4 resulted from inserting balloon or basket into CBD after papillotomy during removing stone.

Managing Perforations Related to Endoscopic Retrograde Cholangiopancreatography

After the initial ERCP, they were immediately treated with conservative management for 5 to 7 days. Three patients received extraordinarily endoscopic retrograde pancreatic drainage ERPD.

Among them, one patient with Billroth II gastrectomy had preampullary perforation and incision bleeding.

Another patient with preampullary perforation had mild acute ERCP-related pancreatitis. All of them recovered successfully by conservative management with an average length of stay in hospital of Post ercp duodenal perforation demographics, ERCP indications, presentation and management of perforation, and outcome.

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