Outcome and management of endoscopic retrograde cholangiopancreatography perforations: A community perspective.
BACKGROUND
Endoscopic retrograde cholangiopancreatography (ERCP) carries a small but significant risk of perforation. Recent data suggest that select patients can be managed non-operatively. We sought to evaluate the management of ERCP perforations at our community medical center.


METHODS
ERCPs performed from 2004 to 2015 were reviewed.


RESULTS
Twenty-one of 2423 patients who underwent ERCP had a perforation (0.9%). ERCP procedures included balloon sweep with/without sphincterotomy and pancreatic duct stent (71%), common bile duct brushing (10%), and pancreatic duct stenting (5%). Duodenal diverticula were present in 3 (14%), and altered anatomy was present in 6 (29%). Seventeen patients were treated nonoperatively; 3 (14%) underwent percutaneous drain placement. Two patients failed nonoperative treatment and required surgery. Four patients required ICU stay, and median post-ERCP LOS was 5 days. The 30-day mortality rate was 1/21 (4.8%).


CONCLUSIONS
Perforations remain a rare, but serious, complication of ERCPs. Nonoperative management is highly successful in carefully selected patients. Early recognition with initiation of antibiotics is paramount. Our community-based practice patterns are similar to those previously published for successful nonoperative management of ERCP perforations.
Department of Medical Education, Gundersen Medical Foundation, La Crosse, WI, USA.
Mallory S
MS
Bray
Department of Medical Research, Gundersen Medical Foundation, La Crosse, WI, USA.
Andrew J
AJ
Borgert
Department of Gastroenterology, Gundersen Health System, La Crosse, WI, USA.
Milan E
ME
Folkers
Department of General Surgery, Gundersen Health System, La Crosse, WI, USA. Electronic address: snkothar@gundersenhealth.org.
Shanu N
SN
Kothari
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D004322:Drainage / Q000706:statistics & numerical data; D005260:Female; D006764:Hospitals, Community; D006784:Hospitals, Teaching; D006801:Humans; D007362:Intensive Care Units; D007416:Intestinal Perforation / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014922:Wisconsin
D000900:Anti-Bacterial Agents
Choledocholithiasis; Endoscopic retrograde cholangiopancreatography; Endoscopic stent; Endoscopy perforation; Outcomes