ERCP-Related Duodenal Perforation; The Prevention and Management / 대한췌담도학회지

ABSTRACT

Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive procedure carrying potential complication such as pancreatitis, hemorrhage, perforation and cholangitis. Most of those complications are mild and usually need a short additional hospitalization periods. Perforation, however, often requires surgical intervention and in this case, the rate of mortality is up to 10%. Prompt diagnosis and proper management are key determinants for successful outcome. For this, endoscopist should be aware of possibility of perforation before procedure especially in high risk patients with altered anatomy such as prior Billroth II or Roux-en-Y anastomosis. After diagnosis of perforation, multidisciplinary approach involving medical, surgical and radiologic interventional subspecialties, is essential. Usually, surgical treatment is needed for type I free wall perforation and medical and endoscopic treatments are recommended for type II-IV perforation. Recently, several anecdotal studies reported successful endoscopic treatment using new devices for type I duodenal wall perforation but it is not warranted that endoscopic treatments can substitute the surgical intervention.