Primary endoscopic approximation suture under cap-assisted endoscopy of an ERCP-induced duodenal perforation.
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.
Lee
Tae Hoon
TH
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.
Bang
Byoung Wook
BW
Jeong
Jee In
JI
Kim
Hyung Gil
HG
Jeong
Seok
S
Park
Seon Mee
SM
Lee
Don Haeng
DH
Park
Sang-Heum
SH
Kim
Sun-Joo
SJ
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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