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Medline ® Abstract for Reference 31

of 'Post-ERCP perforation'

Management of ERCP-related perforations: outcomes of single institution in Korea.
Kim JH, Yoo BM, Kim JH, Kim MW, Kim WH
J Gastrointest Surg. 2009;13(4):728. Epub 2009 Jan 6.
INTRODUCTION: The aim of this study was to analyze clinicoradiologic findings and treatment outcomes of patients with endoscopic retrograde cholangiopancreatography (ERCP)-related perforations. Between May 2003 and November 2007, 2,247 ERCP procedures with or without sphincterotomy were performed at Ajou University Medical Center, Suwon, Korea, and 20 perforations (0.89%) were identified.
DISCUSSION: We retrospectively reviewed medical and surgical records of each patient. Of 18 patients, 11 patients (61.1%) underwent nonsurgical management, and seven patients (38.9%) received surgical management. There were no significant differences in age, gender, and laboratory findings between two groups (P>0.05). The hospital stay was significantly longer in the operative group than that of the conservative group (P<0.05, respectively). The most common cause of perforation was sphincterotomy (n = 8) in the conservative group whereas scope itself (n = 6) in operative group, showing a significant difference between the two groups (P<0.05). The retroperitoneal air was most common findings in eight patients (72.7%) of the conservative group, while six (85.7%) patients of the operative group presented with intraperitoneal air, displaying a significant difference in location of air between the two groups (P<0.05). Most of sphincterotomy-related perforations were managed nonsurgically. However, the scope-related perforations were usually large and required immediate surgery. Moreover, the delayed operation resulted in a longer hospital stay and high morbidity. Therefore, the selective early surgical intervention is suggested when scope-related perforations are discovered.
Department of Surgery, School of Medicine, Ajou University, San-5, Wonchondong, Yeongtonggu, Suwon, 442-749, South Korea.