title: Can a Fully Covered Self-Expandable Metallic Stent be Used Temporarily for the Management of Duodenal Retroperitoneal Perforation During ERCP as a Part of Conservative Therapy?
abstract: OBJECTIVE
  There are no reports comparing the results of conservative/nonsurgical management with the addition of fully covered self-expandable metallic stents (FCSEMS) with the conservative approach in endoscopic retrograde cholangiopancreatography (ERCP)-related duodenal retroperitoneal (type II) perforations. The aim of this study was to evaluate whether the addition of FCSEMS to conventional treatment provides further benefits in the course of type II perforations.
  
  
  METHODS
  A total of 7471 ERCP with sphincterotomy performed between 2007 and 2014 were evaluated, and a total of 25 type II perforations (0.33%) were identified. About 20 patients who were detected during ERCP and biliary cannulation was accomplished were included in the study. Patients were divided into 2 groups: the conservative treatment group (10 patients) and the FCSEMS group (10 patients). Groups were compared for clinical findings, results of serial white blood cell (WBC) counts, the length of hospital stay, the need for surgery, and death, retrospectively.
  
  
  RESULTS
  Five patients in the conservative treatment group and none of the patients in the FCSEMS group had pain requiring narcotic and/or nonsteroidal anti-inflammatory analgesics during the follow-up period (P=0.005). On post-ERCP day 1, in the conservative and the FCSEMS groups, mean WBC counts were 13,218±4410×10 and 8714±3270×10, respectively (P=0.029). The perforation-related length of hospital stay was 15.77±5.21 days in the conservative group and 11.7±3.19 days in the FCSEMS group (P=0.053). Excluding the patient with severe pancreatitis in the conservative group, there were no deaths or need for surgery.
  
  
  CONCLUSIONS
  Compared with conservative treatment alone, the addition of FCSEMS provides further benefits in terms of a painless course, lower WBC counts, and a short hospital stay. FCSEMS can be used as an additional treatment modality in type II perforation.
authors.affiliation: Department Of Gastroenterology, Yuksek Ihtisas Education and Research Hospital, Ankara, Turkey.
authors.forename: Bulent
authors.initials: B
authors.lastname: Odemis
authors.forename: Erkin
authors.initials: E
authors.lastname: Oztas
authors.forename: Ufuk B
authors.initials: UB
authors.lastname: Kuzu
authors.forename: Erkan
authors.initials: E
authors.lastname: Parlak
authors.forename: Selcuk
authors.initials: S
authors.lastname: Disibeyaz
authors.forename: Serkan
authors.initials: S
authors.lastname: Torun
authors.forename: Ertugrul
authors.initials: E
authors.lastname: Kayacetin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D020878:Device Removal; D004386:Duodenum / Q000293:injuries*; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology / Q000601:surgery*; D007902:Length of Stay; D007964:Leukocytosis / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology; D012189:Retrospective Studies; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome