title: Primary endoscopic approximation suture under cap-assisted endoscopy of an ERCP-induced duodenal perforation.
abstract: Duodenal perforation during endoscopic retrograde cholangiopancreatography (ERCP) is a rare complication, but it has a relatively high mortality risk. Early diagnosis and prompt management are key factors for the successful treatment of ERCP-related perforation. The management of perforation can initially be conservative in cases resulting from sphincterotomy or guide wire trauma. However, the current standard treatment for duodenal free wall perforation is surgical repair. Recently, several case reports of endoscopic closure techniques using endoclips, endoloops, or fully covered metal stents have been described. We describe four cases of iatrogenic duodenal bulb or lateral wall perforation caused by the scope tip that occurred during ERCP in tertiary referral centers. All the cases were simply managed by endoclips under transparent cap-assisted endoscopy. Based on the available evidence and our experience, endoscopic closure was a safe and feasible method even for duodenoscope-induced perforations. Our results suggest that endoscopists may be more willing to use this treatment.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Soon Chun Hyang University College of Medicine, Cheonan Hospital, 23-20 Bongmyung-dong, Cheonan 330-721, South Korea.
authors.forename: Tae Hoon
authors.initials: TH
authors.lastname: Lee
authors.forename: Byoung Wook
authors.initials: BW
authors.lastname: Bang
authors.forename: Jee In
authors.initials: JI
authors.lastname: Jeong
authors.forename: Hyung Gil
authors.initials: HG
authors.lastname: Kim
authors.forename: Seok
authors.initials: S
authors.lastname: Jeong
authors.forename: Seon Mee
authors.initials: SM
authors.lastname: Park
authors.forename: Don Haeng
authors.initials: DH
authors.lastname: Lee
authors.forename: Sang-Heum
authors.initials: SH
authors.lastname: Park
authors.forename: Sun-Joo
authors.initials: SJ
authors.lastname: Kim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D004384:Duodenoscopy / Q000379:methods*; D004386:Duodenum / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D013536:Suture Techniques; D014057:Tomography, X-Ray Computed
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