title: A tailored approach to the management of perforations following endoscopic retrograde cholangiopancreatography and sphincterotomy.
abstract: BACKGROUND
  The management of endoscopic retrograde cholangiopancreatography (ERCP)-related perforations remains controversial. Τhe aim of the study was to determine the incidence of perforations following ERCP, their characteristics, operative and non-operative management options and clinical outcome.
  
  
  METHODS
  A retrospective review of ERCP-related perforations, during a 21-year period, was performed. Each perforation was categorized into types I to IV according to the location, mechanism and radiographic evaluation of the injury. Comparisons were made between patients treated operatively and non-operatively.
  
  
  RESULTS
  Forty-four perforations (0.4%) occurred in 9,880 procedures. They were mainly caused by the passage of the endoscope (type I) in 7 (16%) and sphincterotomy (type II) in 30 (68%) patients. The management was non-operative in 32 (72%) and operative in 12 patients. In multivariate analysis, only the type of perforation (type I: endoscope-related) was found significant for predicting operative treatment. The hospital stay was longer for patients requiring an operation (median, 24 vs 9 days). The overall mortality was 2/44 (4.5%). There was no death in the non-operative group.
  
  
  CONCLUSIONS
  The need for immediate operative intervention should be based on the type of injury and clinical findings. Patients with type I perforations should be treated surgically and primary repair should be tried. Patients with type II injuries may be treated initially non-operatively. Delayed operative intervention will be required in a minority of these patients.
authors: University of Athens, Aretaieion Hospital, Athens, Greece.
authors: Andreas
authors: A
authors: Polydorou
authors: Antonios
authors: A
authors: Vezakis
authors: Georgios
authors: G
authors: Fragulidis
authors: Demetrios
authors: D
authors: Katsarelias
authors: Constantinos
authors: C
authors: Vagianos
authors: Georgios
authors: G
authors: Polymeneas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D004386:Duodenum; D005260:Female; D006115:Greece; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology* / Q000473:pathology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D012189:Retrospective Studies; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects*; D016896:Treatment Outcome