ERCP-RELATED PERFORATIONS: COVERT OR OVERT ADVERSE EVENTS? A PROSPECTIVE CASE SERIES
Background Perforations related to endoscopic retrograde cholangiopancreatography are a rare but feared adverse events, with significant morbidity and mortality. In order to describe the potential patient profiles related to post-ERCP perforations we present a case series of three patients, documenting several particular aspects related to their ERCP related complications. Material and methods: Between 01.01.2018 and 31.08.2020 a total of 403 patients underwent therapeutic ERCP in the tertiary medical center represented by “Sf. Spiridon” County Clinical Emergency Hospital, Iasi, Romania. Three duodenal and pancreaticobiliary perforations were identified (0.74%). Results: Three types of perforations (according to Stapfer et al., 2000 classification) were described: type 2, type 3 and type 4. All patients presented patient-related risk factors and developed post-ERCP comorbidities that proved to be of significant impact to their prognosis resulting in two cases of fatal outcome. Given each case particularities, positive diagnosis was established using cross-sectional imaging. The therapeutical approach was complex and included surgical treatment, as advocated in current literature. Conclusions: Post-procedural diagnosis of perforations can prove to be challenging but an early diagnosis, an appropriate therapeutic approach and a well conducted post-procedural patient surveillance can significantly improve patient outcome.
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