Clinical course and proposed treatment strategy for ERCP-related duodenal perforation

A multicenter analysis

Donhaeng Lee, Young Joo Jin, Seok Jeong, Jinhong Kim, Jaechul Hwang, Byungmoo Yoo, Jongho Moon, Sangheum Park, Hogak Kim, Dongki Lee, Yongsun Jeon

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Background and study aims: Endoscopic retrograde cholangiopancreatography (ERCP)-related duodenal perforation is rare but can cause high mortality. Our aim was to assess the clinical outcomes of these events. Method: A total of 59 patients who were diagnosed as having ERCP-related duodenal perforation at six institutions between 2000 and 2007 were enrolled in this multicenter retrospective study. We evaluated complications and mortality associated with ERCP-related duodenal perforation according to injury detection time (IDT), peritoneal irritation signs (PIS), systemic inflammation signs (SIS), and treatment modality in these patients. Results: Of the 59 patients, 41 (69.5 %) and 18 (30.5 %) underwent medical and surgical treatment, respectively. Duodenal perforation-related death was observed in five patients, who had received medical therapy (n = 2) and surgical therapy (n = 3). Among medically treated patients, seven patients (17.1 %) underwent endoscopic clipping immediately after the injury; surgery was not required as a salvage therapy and there were no complications or deaths among these patients. The remaining 34 patients received antibiotics combined with therapeutic fasting and intravenous hydration. Duodenal perforation-related complications depended significantly on IDT (P = 0.0001), treatment modality (P = 0.008), PIS (P = 0.003), and SIS (P = 0.010). The duodenal perforation-related mortality was significantly related to IDT (P = 0.008) and PIS (P = 0.001). Conclusions: IDT, PIS, and SIS appear to be important prognostic factors following ERCP-related duodenal perforation. Medical therapy can be suggested as an initial treatment strategy for ERCP-related duodenal perforation, and if possible, endoscopic clipping is strongly recommended. However, surgical treatment should be considered if the perforation is not expected to seal spontaneously, or if the continuing leakage causes PIS or SIS.

Original languageEnglish
Pages (from-to)806-812
Number of pages7
JournalEndoscopy
Volume45
Issue number10
DOIs
Publication statusPublished - 2013 Aug 5

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Endoscopic Retrograde Cholangiopancreatography
Wounds and Injuries
Inflammation
Therapeutics
Mortality
Salvage Therapy
Multicenter Studies
Fasting
Retrospective Studies
Anti-Bacterial Agents

All Science Journal Classification (ASJC) codes

  • Gastroenterology

Cite this

Lee, Donhaeng ; Jin, Young Joo ; Jeong, Seok ; Kim, Jinhong ; Hwang, Jaechul ; Yoo, Byungmoo ; Moon, Jongho ; Park, Sangheum ; Kim, Hogak ; Lee, Dongki ; Jeon, Yongsun. / Clinical course and proposed treatment strategy for ERCP-related duodenal perforation : A multicenter analysis. In: Endoscopy. 2013 ; Vol. 45, No. 10. pp. 806-812.
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abstract = "Background and study aims: Endoscopic retrograde cholangiopancreatography (ERCP)-related duodenal perforation is rare but can cause high mortality. Our aim was to assess the clinical outcomes of these events. Method: A total of 59 patients who were diagnosed as having ERCP-related duodenal perforation at six institutions between 2000 and 2007 were enrolled in this multicenter retrospective study. We evaluated complications and mortality associated with ERCP-related duodenal perforation according to injury detection time (IDT), peritoneal irritation signs (PIS), systemic inflammation signs (SIS), and treatment modality in these patients. Results: Of the 59 patients, 41 (69.5 {\%}) and 18 (30.5 {\%}) underwent medical and surgical treatment, respectively. Duodenal perforation-related death was observed in five patients, who had received medical therapy (n = 2) and surgical therapy (n = 3). Among medically treated patients, seven patients (17.1 {\%}) underwent endoscopic clipping immediately after the injury; surgery was not required as a salvage therapy and there were no complications or deaths among these patients. The remaining 34 patients received antibiotics combined with therapeutic fasting and intravenous hydration. Duodenal perforation-related complications depended significantly on IDT (P = 0.0001), treatment modality (P = 0.008), PIS (P = 0.003), and SIS (P = 0.010). The duodenal perforation-related mortality was significantly related to IDT (P = 0.008) and PIS (P = 0.001). Conclusions: IDT, PIS, and SIS appear to be important prognostic factors following ERCP-related duodenal perforation. Medical therapy can be suggested as an initial treatment strategy for ERCP-related duodenal perforation, and if possible, endoscopic clipping is strongly recommended. However, surgical treatment should be considered if the perforation is not expected to seal spontaneously, or if the continuing leakage causes PIS or SIS.",
author = "Donhaeng Lee and Jin, {Young Joo} and Seok Jeong and Jinhong Kim and Jaechul Hwang and Byungmoo Yoo and Jongho Moon and Sangheum Park and Hogak Kim and Dongki Lee and Yongsun Jeon",
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Lee, D, Jin, YJ, Jeong, S, Kim, J, Hwang, J, Yoo, B, Moon, J, Park, S, Kim, H, Lee, D & Jeon, Y 2013, 'Clinical course and proposed treatment strategy for ERCP-related duodenal perforation: A multicenter analysis', Endoscopy, vol. 45, no. 10, pp. 806-812. https://doi.org/10.1055/s-0033-1344230

Clinical course and proposed treatment strategy for ERCP-related duodenal perforation : A multicenter analysis. / Lee, Donhaeng; Jin, Young Joo; Jeong, Seok; Kim, Jinhong; Hwang, Jaechul; Yoo, Byungmoo; Moon, Jongho; Park, Sangheum; Kim, Hogak; Lee, Dongki; Jeon, Yongsun.

In: Endoscopy, Vol. 45, No. 10, 05.08.2013, p. 806-812.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Clinical course and proposed treatment strategy for ERCP-related duodenal perforation

T2 - A multicenter analysis

AU - Lee, Donhaeng

AU - Jin, Young Joo

AU - Jeong, Seok

AU - Kim, Jinhong

AU - Hwang, Jaechul

AU - Yoo, Byungmoo

AU - Moon, Jongho

AU - Park, Sangheum

AU - Kim, Hogak

AU - Lee, Dongki

AU - Jeon, Yongsun

PY - 2013/8/5

Y1 - 2013/8/5

N2 - Background and study aims: Endoscopic retrograde cholangiopancreatography (ERCP)-related duodenal perforation is rare but can cause high mortality. Our aim was to assess the clinical outcomes of these events. Method: A total of 59 patients who were diagnosed as having ERCP-related duodenal perforation at six institutions between 2000 and 2007 were enrolled in this multicenter retrospective study. We evaluated complications and mortality associated with ERCP-related duodenal perforation according to injury detection time (IDT), peritoneal irritation signs (PIS), systemic inflammation signs (SIS), and treatment modality in these patients. Results: Of the 59 patients, 41 (69.5 %) and 18 (30.5 %) underwent medical and surgical treatment, respectively. Duodenal perforation-related death was observed in five patients, who had received medical therapy (n = 2) and surgical therapy (n = 3). Among medically treated patients, seven patients (17.1 %) underwent endoscopic clipping immediately after the injury; surgery was not required as a salvage therapy and there were no complications or deaths among these patients. The remaining 34 patients received antibiotics combined with therapeutic fasting and intravenous hydration. Duodenal perforation-related complications depended significantly on IDT (P = 0.0001), treatment modality (P = 0.008), PIS (P = 0.003), and SIS (P = 0.010). The duodenal perforation-related mortality was significantly related to IDT (P = 0.008) and PIS (P = 0.001). Conclusions: IDT, PIS, and SIS appear to be important prognostic factors following ERCP-related duodenal perforation. Medical therapy can be suggested as an initial treatment strategy for ERCP-related duodenal perforation, and if possible, endoscopic clipping is strongly recommended. However, surgical treatment should be considered if the perforation is not expected to seal spontaneously, or if the continuing leakage causes PIS or SIS.

AB - Background and study aims: Endoscopic retrograde cholangiopancreatography (ERCP)-related duodenal perforation is rare but can cause high mortality. Our aim was to assess the clinical outcomes of these events. Method: A total of 59 patients who were diagnosed as having ERCP-related duodenal perforation at six institutions between 2000 and 2007 were enrolled in this multicenter retrospective study. We evaluated complications and mortality associated with ERCP-related duodenal perforation according to injury detection time (IDT), peritoneal irritation signs (PIS), systemic inflammation signs (SIS), and treatment modality in these patients. Results: Of the 59 patients, 41 (69.5 %) and 18 (30.5 %) underwent medical and surgical treatment, respectively. Duodenal perforation-related death was observed in five patients, who had received medical therapy (n = 2) and surgical therapy (n = 3). Among medically treated patients, seven patients (17.1 %) underwent endoscopic clipping immediately after the injury; surgery was not required as a salvage therapy and there were no complications or deaths among these patients. The remaining 34 patients received antibiotics combined with therapeutic fasting and intravenous hydration. Duodenal perforation-related complications depended significantly on IDT (P = 0.0001), treatment modality (P = 0.008), PIS (P = 0.003), and SIS (P = 0.010). The duodenal perforation-related mortality was significantly related to IDT (P = 0.008) and PIS (P = 0.001). Conclusions: IDT, PIS, and SIS appear to be important prognostic factors following ERCP-related duodenal perforation. Medical therapy can be suggested as an initial treatment strategy for ERCP-related duodenal perforation, and if possible, endoscopic clipping is strongly recommended. However, surgical treatment should be considered if the perforation is not expected to seal spontaneously, or if the continuing leakage causes PIS or SIS.

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U2 - 10.1055/s-0033-1344230

DO - 10.1055/s-0033-1344230

M3 - Article

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