Ekrem Çakar*, Bünyamin Gürbulak*, Şükrü Çolak*, Yiğit Düzköylü**, Ufuk Oğuz İdiz*, Hasan Bektaş*
*Istanbul Training and Research Hospital, Department of General Surgery, Fatih 34098, Istanbul, Turkey - **TürkiyeYüksek İhtisas Training and Research Hospital, Department of Gastroenterological Surgery, Ankara, Turkey
Objective: Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive method used for the diagnosis and treatment of pancreatic and biliary diseases. ERCP-related perforations seen in 0.08 to 2% and mortality rates varies in 3 to 20%.
The diagnosis of post-ERCP perforations are difficult and localization of the perforation can lead to heterogeneity in the symptoms, laboratory and imaging studies. We aimed to evaluate our cases of ERCP-related perforation encountered in our clinic and compare the results in the light of current literature.
Material and methods: Age, gender, comorbid diseases, indication for ERCP and overall results were determined retrospectively from hospital datum files and iatrogenic perforation was determined in 10 patients (0.11%).
Four types of perforation have been defined based on mechanism of perforation, clinical status and type of surgery. While cases with type 1 perforation were operated at emergent conditions, conservative approach and/or minimally invasive procedures were chosen initially for type 2,3 and 4 injuries.
Result: During the last 12 years, 8568 ERCP procedures have been performed and 10 of patients (0.11%) were hospitalized with diagnosis of ERCP-related iatrogenic gastrointestinal perforation. Median age of the patients was found to be 64 (19-79) involving nine females (90%) and one male (10%). Perforation determined in four of patients during ERCP procedure. Four patients were followed-up conservatively, 6 patients were operated.
Conclusion: We encountered prolonged and challenging cannulation in 4 patients, papilla localised at the edge of the diverticula in 3 patients and altered anatomy in one patient. These conditions have been determined as risk factors for ERCP perforations.
ERCP-related perforations, Billiary metallic stents, Conservative management.