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01-12-2018

The importance of early recognition in management of ERCP-related perforations

Authors: Jason G. Bill, Zachary Smith, Joseph Brancheck, Jeffrey Elsner, Paul Hobbs, Gabriel D. Lang, Dayna S. Early, Koushik Das, Thomas Hollander, Maria B. Majella Doyle, Ryan C. Fields, William G. Hawkins, Steven M. Strasberg, Chet Hammill, William C. Chapman, Steven Edmundowicz, Daniel K. Mullady, Vladimir M. Kushnir

Published in: Surgical Endoscopy | Issue 12/2018

Abstract

Background

Iatrogenic perforations related to endoscopic retrograde cholangiopancreatography (ERCP) are rare events, carrying with it a mortality of up to 8%. Given the rarity of this adverse event, there remains limited data and continued uncertainties when choosing therapeutic strategies. Our aims were to evaluate the management of ERCP-related perforations and compare outcomes based on timing of recognition.

Methods

The endoscopic databases of two tertiary care centers were interrogated to identify consecutive adult patients who sustained ERCP-related perforation over a 10-year period from 2006 to 2016. Electronic medical records were reviewed to extract demographic data, perforation type, management strategies, clinical data, and patient outcomes.

Results

14,045 ERCP’s were performed during our 10-year study period. Sixty-three patients (average age 62.3 ± 2.38 years, 76% female) with ERCP-related perforations were included. Stapfer I perforations were found in 14 (22.2%) patients, Stapfer II in 24 (38.1%), and Stapfer III and IV perforations were identified in 16 (25.4%) and 9 (14.28%), respectively. Forty-seven (74.6%) perforations were recognized immediately during the ERCP, whereas 16 (25.4%) were recognized late. Endoscopic therapy was attempted in 35 patients in whom perforations were identified immediately, and was technically successful in 33 (94.3%). In all, 4 (1 immediate/ 3 delayed) patients required percutaneous drainage and 9 (5 immediate/ 4 delayed) surgery. Length of hospital stay, ICU admission were significantly shorter and incidence of SIRS was significantly lower when perforation was recognized immediately.

Conclusions

Immediate recognition of ERCP-related perforations leads to more favorable patient outcomes; with lower incidence of SIRS, less need for ICU level care, and shorter hospital stay.

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Title: The importance of early recognition in management of ERCP-related perforations
Authors: Jason G. Bill
Zachary Smith
Joseph Brancheck
Jeffrey Elsner
Paul Hobbs
Gabriel D. Lang
Dayna S. Early
Koushik Das
Thomas Hollander
Maria B. Majella Doyle
Ryan C. Fields
William G. Hawkins
Steven M. Strasberg
Chet Hammill
William C. Chapman
Steven Edmundowicz
Daniel K. Mullady
Vladimir M. Kushnir
Publication date: 01-12-2018
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 12/2018
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-018-6235-8

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

The importance of early recognition in management of ERCP-related perforations

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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