Surgical outcomes after endoscopic retrograde cholangiopancreatography and sphincterotomy associated duodenal perforations: Experience from a tertiary care centre in India

Srinivas Bojanapu, Uma Vajpeyajula, A. Das, N. Mehta, S. Nundy
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Abstract

Background: The advent and progress of endoscopic retrograde cholangiopancreatography (ERCP) for hepato-pancreaticobiliary diseases have introduced a paradigm shift in their treatment but have also been associated with complications that have been difficult to manage. We examined the outcome of patients who had duodenal perforations from periampullary endoscopic procedures who needed surgical intervention. Aim: To study the outcomes in patients who underwent surgical intervention for ERCP associated duodenal perforation. Materials and Methods: Between January 2001 and November 2021, we retrieved the details of 20 patients who had been operated on for duodenal perforations following ERCP from a prospectively maintained database. Results: There were nine males and 11 females whose mean age was 51.3 (range 29–81) years. The most common indication for the endoscopic procedure was choledocholithiasis in 16, followed by biliary stricture in 3 and malignancy in 1. The median duration between the diagnosis of perforation and surgery was 8.3 days (range 0–48). The mean hospital stay was 21.5 (range 5–60) days. Four (20%) patients underwent re-exploration. Seven (35%) patients died, in all of whom the diagnosis had been missed at the time of the procedure (P = 0.015). Eighty per cent of mortality occurred in patients with a Boey score of three. Conclusion: ERCP-related duodenal perforations though uncommon, are dreaded complications and do not have universally accepted standard management. Patients with delayed diagnosis of duodenal perforation and higher Boey scores have higher mortality rates.
内镜逆行胆管造影和括约肌切开术合并十二指肠穿孔后的手术结果:来自印度三级保健中心的经验
背景:内窥镜逆行胆管造影(ERCP)治疗肝-胰胆道疾病的出现和进展已经引入了其治疗模式的转变,但也与难以控制的并发症相关。我们研究了因壶腹周围内窥镜手术导致十二指肠穿孔而需要手术干预的患者的结果。目的:探讨ERCP相关十二指肠穿孔手术治疗的预后。材料和方法:2001年1月至2021年11月,我们从前瞻性维护的数据库中检索了20例经ERCP手术治疗十二指肠穿孔患者的详细资料。结果:男性9例,女性11例,平均年龄51.3岁(29 ~ 81岁)。内镜手术最常见的指征是16例胆总管结石,3例胆道狭窄,1例恶性肿瘤。从诊断穿孔到手术的中位时间为8.3天(范围0-48天)。平均住院时间为21.5天(5-60天)。4例(20%)患者再次探查。7例(35%)患者死亡,其中所有患者在手术时均未确诊(P = 0.015)。80%的死亡率发生在Boey评分为3分的患者中。结论:ercp相关的十二指肠穿孔虽不常见,但却是一种可怕的并发症,目前尚无普遍接受的标准治疗方法。十二指肠穿孔诊断延迟和Boey评分较高的患者死亡率较高。
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