Clinical outcomes of patients who experienced perforation associated with endoscopic retrograde cholangiopancreatography.
BACKGROUND
Perforation after endoscopic retrograde cholangiopancreatography (ERCP) is a rare but severe complication. The purpose of this study was to assess the clinical outcomes with perforations after ERCP from a large number of cases.


METHODS
Among 11,048 patients who underwent ERCP during 10 years, medical records from 68 patients (0.62 %) who experienced post-ERCP perforation with radiologic, endoscopic, or surgical evidence were retrospectively reviewed. We assessed the clinical outcomes of patients and analyzed the factors associated with poor outcomes, which were defined as mortality, prolonged hospital stay due to complications, or loss of chance of cure in the case of cancer.


RESULTS
Twenty-nine patients were male, and the median age was 65.0 years. Therapeutic ERCP was performed in 52 cases (77 %). Common mechanisms of perforation were endoscopic sphincterotomy (37 %), catheter or guidewire (34 %), and endoscope (19 %). In contrast to 9 patients who underwent emergent operation, 59 patients (87 %) were conservatively treated. In 44 patients, perforation was detected during the procedure; however, detection after 24 h or permitted oral intake before detection occurred in 18 cases (27 %). Although 58 patients recovered without poor outcomes, 10 patients (15 %) experienced poor outcomes, which consisted of mortality (n = 4), loss of chance of cure (n = 2), and prolonged hospital stay without surgery more than 1 month due to complications (n = 4). By multiple logistic regression analysis, perforation by endoscope and rebound tenderness was statistically associated with poor outcomes (odds ratio: 13.7 and 7.3, respectively).


CONCLUSIONS
Most patients fully recovered from perforation; however, some patients experienced grave outcomes, including mortality. Perforation by endoscope and rebound tenderness was significantly associated with poor outcomes.
Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea. drjaihwan@gmail.com
Jaihwan
J
Kim
Sang Hyub
SH
Lee
Woo Hyun
WH
Paik
Byeong Jun
BJ
Song
Jin Hyeok
JH
Hwang
Ji Kon
JK
Ryu
Yong-Tae
YT
Kim
Yong Bum
YB
Yoon
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001659:Biliary Tract / Q000293:injuries*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D004386:Duodenum / Q000293:injuries*; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult