Back to Program | 2010 Program and Abstracts Overview | 2010 Posters

Background: Although endoscopic retrograde cholangiopancreatography (ERCP) is widely regarded as a safe procedure, it is associated with significant morbidity and mortality. Duodenal perforation is one of the most serious complication of ERCP. Its management is still controversial, some authors recommend surgical, others conservative treatment.METHODS: A retrospective chart review was conducted to identify 11 patients (men, n=6, women, n=5, mean age: 71.3 years) treated at our institution for ERCP-related duodenal perforations. Between January 2000 and October 2009 4,015 ERCP procedures were performed (perforation rate: 0.4%; in one patient ERCP was performed elsewhere). Study variables included indication of ERCP, clinical presentation, diagnostic procedures, time to diagnosis and treatment, location of injury, management, length of hospital stay, and survival.RESULTS: Four of the perforations were discovered during ERCP, five requiring radiologic imaging for diagnosis. In one patient diagnosis was made only at autopsy, in another patient perforation came 3 years after the procedure through a dislocated stent. Four of 11 perforations were stent related, in two patients ERCP was performed in a non-anatomical situation (Billroth II gastroenterostomy). Four patients (36%) were treated surgically with nil mortality. Five patients were managed conservatively with a successful outcome, and two patients died after conservative treatment (18%). Three of four patients underwent surgery within 24 h after the ERCP, with only one patient undergoing surgery after 24 h. Operative treatment included: hepaticojejunostomy and duodenostomy (in one patient), suture of the perforation with T-drain (in one patient) suture only (in two patients). Average length of stay was 20.1 days.CONCLUSIONS: Post-ERCP duodenal perforations are associated with significant morbidity and mortality. Immediate radiological evaluation and close surgical monitoring is needed. Management should be individually tailored based on clinical and radiological findings. A treatment algorithm is suggested based on the study result.