title: Management of endoscopic retrograde cholangiopancreatography-related perforations: Experience of a tertiary center.
abstract: Endoscopic retrograde cholangiopancreatography-induced perforation (EP) is a rare but severe complication. We describe the risk factors, management, and outcome of ERCP-induced perforations in a tertiary center.
  
  
  
  This is a case-control study. All EP cases between March 2004 and February 2015 were compared to a control group without perforation. Data on patients, procedures, presentation, perforation type, radiologic findings, management, and outcome were assessed.
  
  
  
  Of 6,934 endoscopic retrograde cholangiopancreatographies, 37 patients (0.53%) had EP. Independent risk factors included failure of cannulation, a procedure described as "difficult," performing a precut and resection of a periampullary adenoma. Perforation was diagnosed during the procedure in 7 patients (19%). Median interval for diagnosis was 11 hours (range: 0-201 hours), with 84% diagnosed within 30 hours. The periampullary region was the most common EP site (51%). Twenty-nine patients (78%) were managed conservatively and 8 (22%) were operated. Three patients failed conservative management and required delayed operation. Failure of conservative management had a detrimental effect on morbidity and duration of stay. All patients who required operative intervention had perforation of either the duodenal free wall or the periampullary region.
  
  
  
  Clear risk factors can be used to raise suspicion of EP. Early diagnosis and management are critical for better outcome. This is especially important when operative intervention is indicated. Nonetheless, the majority of patients may be managed conservatively.
authors.affiliation: Department of General Surgery B, Division of General Surgery, Tel-Aviv Sourasky Medical Center, The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. Electronic address: roiweiser@yahoo.com.
authors.forename: Roi
authors.initials: R
authors.lastname: Weiser
authors.affiliation: Department of General Surgery B, Division of General Surgery, Tel-Aviv Sourasky Medical Center, The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Niv
authors.initials: N
authors.lastname: Pencovich
authors.affiliation: Institute of Gastroenterology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Liat
authors.initials: L
authors.lastname: Mlynarsky
authors.affiliation: Clinical Performance Research Unit, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
authors.forename: Adi
authors.initials: A
authors.lastname: Berliner-Senderey
authors.affiliation: Department of General Surgery B, Division of General Surgery, Tel-Aviv Sourasky Medical Center, The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Guy
authors.initials: G
authors.lastname: Lahat
authors.affiliation: Institute of Gastroenterology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Erwin
authors.initials: E
authors.lastname: Santo
authors.affiliation: Department of General Surgery B, Division of General Surgery, Tel-Aviv Sourasky Medical Center, The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Klausner
authors.affiliation: Department of General Surgery B, Division of General Surgery, Tel-Aviv Sourasky Medical Center, The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Ido
authors.initials: I
authors.lastname: Nachmany
mesh_terms: D000367:Age Factors; D000368:Aged; D016022:Case-Control Studies; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects* / Q000379:methods; D000072700:Conservative Treatment / Q000379:methods*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004386:Duodenum / Q000293:injuries*; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D015994:Incidence; D007416:Intestinal Perforation / Q000209:etiology / Q000628:therapy*; D007557:Israel; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D015996:Survival Rate; D062606:Tertiary Care Centers; D016896:Treatment Outcome