-Original-

Causes and Management of Endoscopic Retrograde Cholangiopancreatography-Related Perforation: A Retrospective Study

Tetsuya Shimizu¹, Masato Yoshioka¹, Akira Matsushita¹, Keiko Kaneko², Junji Ueda¹, Mampei Kawashima¹, Toshiyuki Irie¹, Takashi Ono¹, Hiroyasu Furuki¹, Tomohiro Kanda¹, Yoshiaki Mizuguchi¹, Yoichi Kawano¹, Yoshiharu Nakamura¹ and Hiroshi Yoshida¹

¹Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan
²Department of Gastroenterology, Nippon Medical School, Tokyo, Japan

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is essential for diagnosing and treating biliopancreatic disease. Because ERCP-related perforation can result in death, therapeutic decisions are important. The aim of this study was to determine the cause of ERCP-related perforation and suggest appropriate management.
Methods: Between January 1999 and August 2022, 7,896 ERCPs were performed in our hospital. We experienced 15 cases (0.18%) of ERCP-related perforation and conducted a retrospective review.
Results: Of the 15 patients, 6 were female and 9 were male, and the mean age was 77.1 years. According to Stapfer's classification, the 15 cases of ERCP-related perforation comprised 3 type I (duodenum), 3 type II (periampullary), 9 type III (distal bile duct or pancreatic duct), and no type IV cases. Fourteen of 15 (92.6%) were diagnosed during ERCP. The main cause of perforation was scope-induced damage, endoscopic sphincterotomy, and instrumentation penetration in type I, II, and III cases, respectively. Four patients with severe abdominal pain and extraluminal fluid collection underwent emergency surgery for repair and drainage. One type III patient with distal bile duct cancer underwent pancreaticoduodenectomy on day 6. Three type III patients with only retroperitoneal gas on computed tomography (CT) performed immediately after ERCP had no symptoms and needed no additional treatment. Seven of the 15 patents were treated by endoscopic nasobiliary drainage (n=5) or CT-guided drainage (n=2). There were no deaths, and all patients were discharged after treatment.
Conclusions: Early diagnosis and appropriate treatment are important in managing ERCP-related perforation.

J Nippon Med Sch 2023; 90: 316-325

Keywords
ERCP, perforation, treatment, surgery

Correspondence to
Tetsuya Shimizu, MD, Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
tetsuya@nms.ac.jp

Received, October 22, 2022
Accepted, January 26, 2023