Division of Gastroenterology, Department of Internal Medicine, Soon Chun Hyang University College of Medicine, Cheonan Hospital, 23-20 Bongmyung-dong, Cheonan 330-721, South Korea.
World J Gastroenterol. 2010 May 14;16(18):2305-10. doi: 10.3748/wjg.v16.i18.2305.
Duodenal perforation during endoscopic retrograde cholangiopancreatography (ERCP) is a rare complication, but it has a relatively high mortality risk. Early diagnosis and prompt management are key factors for the successful treatment of ERCP-related perforation. The management of perforation can initially be conservative in cases resulting from sphincterotomy or guide wire trauma. However, the current standard treatment for duodenal free wall perforation is surgical repair. Recently, several case reports of endoscopic closure techniques using endoclips, endoloops, or fully covered metal stents have been described. We describe four cases of iatrogenic duodenal bulb or lateral wall perforation caused by the scope tip that occurred during ERCP in tertiary referral centers. All the cases were simply managed by endoclips under transparent cap-assisted endoscopy. Based on the available evidence and our experience, endoscopic closure was a safe and feasible method even for duodenoscope-induced perforations. Our results suggest that endoscopists may be more willing to use this treatment.
经内镜逆行胰胆管造影（ERCP）期间发生十二指肠穿孔是一种罕见的并发症，但它具有相对较高的死亡率风险。早期诊断和及时治疗是 ERCP 相关穿孔成功治疗的关键因素。对于由括约肌切开术或导丝创伤引起的穿孔，最初可以采用保守治疗。然而，目前十二指肠游离壁穿孔的标准治疗方法是手术修复。最近，已经描述了使用内镜夹、内镜套扎器或全覆膜金属支架进行内镜下闭合技术的几个病例报告。我们描述了在三级转诊中心进行 ERCP 时由内镜尖端引起的医源性十二指肠球部或侧壁穿孔的 4 个病例。所有病例均在透明帽辅助内镜下单纯使用内镜夹进行治疗。基于现有证据和我们的经验，即使是由十二指肠镜引起的穿孔，内镜下闭合也是一种安全可行的方法。我们的结果表明，内镜医生可能更愿意使用这种治疗方法。
