ERCP-RELATED PERFORATIONS: COVERT OR OVERT ADVERSE EVENTS? A PROSPECTIVE CASE SERIES

https://www.doi.org/10.22551/MSJ.2021.01.10

  • PLESCUTA Roxana “Sf. Spiridon” County Clinical Emergency Hospital of Iasi, Romania
  • BALAN G. G. “Sf. Spiridon” County Clinical Emergency Hospital of Iasi, Romania
  • SFARTI C. V. “Sf. Spiridon” County Clinical Emergency Hospital of Iasi, Romania
  • MITRICA Dana Elena “Sf. Spiridon” County Clinical Emergency Hospital of Iasi, Romania
  • GILCA BLANARIU Georgiana “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • CIUHODARU Octavia “Sf. Spiridon” County Clinical Emergency Hospital of Iasi, Romania
  • TRIFAN Anca “Sf. Spiridon” County Clinical Emergency Hospital of Iasi, Romania
  • VLAD N. “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Abstract

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.

Author Biographies

PLESCUTA Roxana, “Sf. Spiridon” County Clinical Emergency Hospital of Iasi, Romania

Institute of Gastroenterology and Hepatology

BALAN G. G., “Sf. Spiridon” County Clinical Emergency Hospital of Iasi, Romania

Institute of Gastroenterology and Hepatology
“Grigore T. Popa” University of Medicine and Pharmacy of Iasi, Romania
Faculty of Medicine

SFARTI C. V., “Sf. Spiridon” County Clinical Emergency Hospital of Iasi, Romania

Institute of Gastroenterology and Hepatology
“Grigore T. Popa” University of Medicine and Pharmacy of Iasi, Romania
 Faculty of Medicine

MITRICA Dana Elena, “Sf. Spiridon” County Clinical Emergency Hospital of Iasi, Romania

Institute of Gastroenterology and Hepatology
“Grigore T. Popa” University of Medicine and Pharmacy of Iasi, Romania
Faculty of Medicine

GILCA BLANARIU Georgiana, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine

CIUHODARU Octavia, “Sf. Spiridon” County Clinical Emergency Hospital of Iasi, Romania

Institute of Gastroenterology and Hepatology

TRIFAN Anca, “Sf. Spiridon” County Clinical Emergency Hospital of Iasi, Romania

Institute of Gastroenterology and Hepatology
“Grigore T. Popa” University of Medicine and Pharmacy of Iasi, Romania
Faculty of Medicine

VLAD N., “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine

References

1. Catinean A, Motocu R, Fetica B, Mezei A. Epstein-Barr virus-associated gastric ulcer mimicking gastric neoplasia: a case report. Medical Ultrasonography 2019; 21(1): 96-98.
2. Rabie ME, Mir NH, Al Skaini MS, et al. Operative and non-operative management of endoscopic retrograde cholangiopancreatography-associated duodenal injuries. Ann R Coll Surg Engl 2013; 95(4): 285-290.
3. Cirocchi R, Kelly MD, Griffiths EA, et al. A systematic review of the management and outcome of ERCP related duodenal perforations using a standardized classification system. The Surgeon 2017; XX: 1-9.
4. Cotton PB, Garrow DA, Gallagher J, Romagnuolo J. Risk factors for complications after ERCP: a multivariate analysis of 11,497 procedures over 12 years. Gastrointest Endosc 2009; 70(1): 80-88.
5. Silviera ML, Seamon MJ, Porshinski B, et al. Complications related to the endoscopic retrograde cholangiopancreatography: a comprehensive clinical review. J Gastrointestinal Liver Dis 2009; 18: 73-82.
6. Chandrasekhara V, Khashab MA, Muthusamy VR, et al. Adverse events associated with ERCP. Gastrointest Endosc 2017; 85: 32-47.
7. Machado NO. Management of duodenal perforation post-endoscopic retrograde cholangiopancreatog-raphy. When and whom to operate and what factors determine the outcome? A review article. JOP 2012; 13: 18-25.
8. Guda NM, Freeman ML. Overview of ERCP Complications: Prevention and Management, in Lee LS (ed). ERCP and EUS. A Case-Based Approach. New York: Springer, 2015, 37-56.
9. Feng Y, Zhu H, Chen X, et al. Comparison of endoscopic papillary large balloon dilation and endo-scopic sphincterotomy for retrieval of choledocholithiasis: a meta-analysis of randomized controlled trials. J Gastroenterol 2012; 47: 655-663.
10. Teoh AY, Cheung FK, Hu B, et al. Randomized trial of endoscopic sphincterotomy with balloon dilation versus endoscopic sphincterotomy alone for removal of bile duct stones. Gastroenterology 2013; 144: 341-345.
11. Seo YR, Moon JH, Choi JH, et al. Comparison of endoscopic papillary balloon dilation and sphinc-terotomy in young patients with CBD stones and gallstones. Dig Dis Sci 2014; 52: 1042-1047.
12. Avgerinos DV, Llaguna OH, Lo AY, et al. Management of endoscopic retrograde cholangiopancrea-tography: related duodenal perforations. Surg Endosc 2009; 23: 833-838.
13. Morgan KA, Fontenot BB, Ruddy JM, Mickey S, Adams DB. Endoscopic retrograde cholangiopan-creatography gut perforations: when to wait! When to operate! Am Surg 2009; 75(6): 477-484.
14. Preetha M, Chung YF, Chan WH, et al. Surgical management of endoscopic retrograde cholangi-opancreatography-related perforations. ANZ J Surg 2003; 73: 1011-1014.
15. Fatima J, Baron TH, Topazian MD, et al. Pancreaticobiliary and duodenal perforations after periam-pullary endoscopic procedures. Arch Surg 2007; 142: 448-454.
16. Assalia A, Suissa A, Ilivitzki A, et al. Validity of Clinical Criteria in the Management of endoscopic retrograde cholangiopancreatography-related duodenal perforations. Arch Surg 2007; 142: 1059-1064.
17. Balan GG, Arya M, Catinean A, et al. Anatomy of Major Duodenal Papilla Influences ERCP Out-comes and Complication Rates: A Single Center Prospective Study. Journal of Clinical Medicine 2020; 9(6): 1637 / doi.org/10.3390/jcm9061637.
Published
2021-03-30
Section
INTERNAL MEDICINE - PEDIATRICS