Management of ERCP-Related Perforations: Outcomes of Single Institution in Korea
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract(2009)
摘要
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.
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关键词
ERCP-related perforation, Nonsurgical management, Surgery
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