title: Management of duodenal and pancreaticobiliary perforations associated with periampullary endoscopic procedures.
abstract: BACKGROUND
  The purpose of this study was to determine the incidence and outcome of pancreaticobiliary and duodenal (PB/D) perforations from periampullary endoscopic procedures and to examine whether clinical indexes are predictive of the need for operative management.
  
  
  METHODS
  A retrospective review compared patients who had operative intervention for PB/D perforation with those managed nonoperatively.
  
  
  RESULTS
  Thirty-two PB/D perforations occurred in 4,919 procedures (.6%). Twelve (37%) required operation; 20 (63%) were successfully managed nonoperatively. Radiographic imaging was not helpful in predicting the need for operation. A clinical scoring system was predictive of the need for operative management. The length of stay and morbidity rates were higher in the operatively managed patients.
  
  
  CONCLUSIONS
  Most endoscopic PB/D perforations can be successfully managed without operation and, clinical indices are most predictive in determining the need for surgery. Further prospective evaluation of this scoring system may help guide the need for and timing of operative intervention for PB/D perforations.
authors.affiliation: Department of Surgery, University of Colorado, Denver Health Sciences Center, 12631 E 17th Avenue, C-313, PO Box 6511, Aurora, CO 80045, USA.
authors.forename: Kelly
authors.initials: K
authors.lastname: Knudson
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Raeburn
authors.forename: Robert C
authors.initials: RC
authors.lastname: McIntyre
authors.forename: Raj J
authors.initials: RJ
authors.lastname: Shah
authors.forename: Raj J
authors.initials: RJ
authors.lastname: Shaw
authors.forename: Yang K
authors.initials: YK
authors.lastname: Chen
authors.forename: William R
authors.initials: WR
authors.lastname: Brown
authors.forename: Gregory
authors.initials: G
authors.lastname: Stiegmann
mesh_terms: D001652:Bile Ducts / Q000293:injuries; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D003120:Colorado / Q000453:epidemiology; D004386:Duodenum / Q000293:injuries*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007416:Intestinal Perforation / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D010183:Pancreatic Ducts / Q000293:injuries*; D012189:Retrospective Studies; D012307:Risk Factors; D012421:Rupture; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014950:Wounds, Penetrating / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*