title: Management of perforation after endoscopic retrograde cholangiopancreatography.
abstract: BACKGROUND
  Endoscopic retrograde cholangiopancreatography (ERCP)-related perforation is an infrequent complication. It is associated with significant morbidity and mortality. The present study is an evaluation of experience with management and outcomes of ERCP-related perforations and a review of relevant literature.
  
  
  METHODS
  Between January 2008 and January 2015, a total of 9383 ERCPs were performed in endoscopy unit. A total of 29 perforations (0.33%) were identified and retrospectively reviewed.
  
  
  RESULTS
  Of the 29 patients, 18 were female and 11 patients were male, with mean age of 70.5 years (range 33-99 years). According to Stapfer's classification, the 29 patients with ERCP related perforations included 5 type 1 perforations, 14 type 2 perforations, 7 type 3 perforations, and 3 cases of type 4 perforation. In total, 15 of 29 patients with ERCP perforation were operated on. Nine (60%) of those who underwent surgery were discharged uneventful, but 6 (40%) patients died due to postoperative complications and/or associated comorbidities. Seven (24.1%) of 29 patients had undergone endoscopic treatment and 5 of the 7 were discharged from the hospital without any problems; however, peritonitis occurred in 2 patients whose initial endoscopic treatment failed. The first of these 2 patients underwent surgery and was discharged uneventfully, but second patient, who refused surgery, died due to sepsis. Six patients were successfully treated with conservative management. Surgery could not be performed in the remaining 2 patients, who died of sepsis following peritonitis; 1 refused surgery, the other had sudden cardiopulmonary arrest during induction of general anesthesia. Mean hospital stay was 13.2 days (range: 2-57 days). In all, 9 (31%) patients died during period of the study.
  
  
  CONCLUSIONS
  ERCP-related perforation is uncommon complication, but an extremely serious condition. Early diagnosis and prompt management are most important to reduce associated significant morbidity and mortality rates. The most appropriate treatment course should be determined on case-by-case basis.
authors.affiliation: Department of General Surgery, İzmir Katip Çelebi University Atatürk Training and Researh Hospital, İzmir-Turkey. tavusbay3@gmail.com.
authors.forename: Cengiz
authors.initials: C
authors.lastname: Tavusbay
authors.affiliation: Department of Gastroenterology, İzmir Katip Çelebi University Atatürk Training and Researh Hospital, İzmir-Turkey.
authors.forename: Emrah
authors.initials: E
authors.lastname: Alper
authors.affiliation: Department of General Surgery, İzmir Katip Çelebi University Atatürk Training and Researh Hospital, İzmir-Turkey.
authors.forename: Melek
authors.initials: M
authors.lastname: Gökova
authors.affiliation: Department of General Surgery, İzmir Katip Çelebi University Atatürk Training and Researh Hospital, İzmir-Turkey.
authors.forename: Erdinç
authors.initials: E
authors.lastname: Kamer
authors.affiliation: Department of General Surgery, İzmir Katip Çelebi University Atatürk Training and Researh Hospital, İzmir-Turkey.
authors.forename: Haldun
authors.initials: H
authors.lastname: Kar
authors.affiliation: Department of General Surgery, İzmir Katip Çelebi University Atatürk Training and Researh Hospital, İzmir-Turkey.
authors.forename: Kemal
authors.initials: K
authors.lastname: Atahan
authors.affiliation: Department of General Surgery, İzmir Katip Çelebi University Atatürk Training and Researh Hospital, İzmir-Turkey.
authors.forename: Oğuzhan
authors.initials: O
authors.lastname: Özşay
authors.affiliation: Department of General Surgery, İzmir Katip Çelebi University Atatürk Training and Researh Hospital, İzmir-Turkey.
authors.forename: Özlem
authors.initials: Ö
authors.lastname: Gür
authors.affiliation: Department of General Surgery, İzmir Katip Çelebi University Atatürk Training and Researh Hospital, İzmir-Turkey.
authors.forename: Necat
authors.initials: N
authors.lastname: Cin
authors.affiliation: Department of General Surgery, İzmir Katip Çelebi University Atatürk Training and Researh Hospital, İzmir-Turkey.
authors.forename: Emir
authors.initials: E
authors.lastname: Çapkınoğlu
authors.affiliation: Department of General Surgery, İzmir Katip Çelebi University Atatürk Training and Researh Hospital, İzmir-Turkey.
authors.forename: Evren
authors.initials: E
authors.lastname: Durak
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D004378:Duodenal Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome; D014421:Turkey / Q000453:epidemiology