title: Validity of clinical criteria in the management of endoscopic retrograde cholangiopancreatography related duodenal perforations.
abstract: OBJECTIVE
  To assess the validity of predetermined clinical and radiologic criteria in the management of endoscopic retrograde cholangiopancreatography (ERCP)-related duodenal perforations (DPs).
  
  
  METHODS
  Prospective case series.
  
  
  METHODS
  Tertiary medical facility.
  
  
  METHODS
  Twenty-two individuals with ERCP-related DPs.
  
  
  METHODS
  The guidelines advocated operative management for patients with free contrast leak and those with positive peritoneal signs or other indicators suggesting sepsis irrespective of the mechanism or location of injury.
  
  
  METHODS
  Thirty-day mortality rates, success of nonoperative management, and complications related to nonoperative and operative policies.
  
  
  RESULTS
  Diagnosis of DP was accomplished early (within 6 hours of ERCP) in 20 of 22 patients (91%). Three patients with early positive peritoneal signs were treated surgically; 2 of them sustained injury from the endoscope, and the third by papillotomy. All 3 patients had significant findings justifying immediate surgery. Nineteen patients with retroperitoneal DPs due to papillotomy or guidewire insertion were treated nonoperatively. In patients diagnosed early (n = 17), only 1 failure (6%) occurred. In the 2 patients with delayed diagnosis, there was 1 failure, which culminated in death.
  
  
  CONCLUSIONS
  Our results might validate the role of clinical criteria for the selective management of ERCP-related DPs. These criteria were found to correlate well with radiologic findings and the mechanism of injury.
authors.affiliation: Laparoscopic Service, Department of Surgery B, Rambam Medical Center Center and the Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. assaliaa@aol.com
authors.forename: Ahmad
authors.initials: A
authors.lastname: Assalia
authors.forename: Alain
authors.initials: A
authors.lastname: Suissa
authors.forename: Anat
authors.initials: A
authors.lastname: Ilivitzki
authors.forename: Ahmad
authors.initials: A
authors.lastname: Mahajna
authors.forename: Kamal
authors.initials: K
authors.lastname: Yassin
authors.forename: Moshe
authors.initials: M
authors.lastname: Hashmonai
authors.forename: Michael Moshe
authors.initials: MM
authors.lastname: Krausz
mesh_terms: D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D004378:Duodenal Diseases / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies