Department of Internal Medicine, Inha University School of Medicine, Incheon, South Korea.
Endoscopy. 2013 Oct;45(10):806-12. doi: 10.1055/s-0033-1344230. Epub 2013 Aug 1.
Endoscopic retrograde cholangiopancreatography (ERCP)-related duodenal perforation is rare but can cause high mortality. Our aim was to assess the clinical outcomes of these events.
A total of 59 patients who were diagnosed as having ERCP-related duodenal perforation at six institutions between 2000 and 2007 were enrolled in this multicenter retrospective study. We evaluated complications and mortality associated with ERCP-related duodenal perforation according to injury detection time (IDT), peritoneal irritation signs (PIS), systemic inflammation signs (SIS), and treatment modality in these patients.
Of the 59 patients, 41 (69.5 %) and 18 (30.5 %) underwent medical and surgical treatment, respectively. Duodenal perforation-related death was observed in five patients, who had received medical therapy (n = 2) and surgical therapy (n = 3). Among medically treated patients, seven patients (17.1 %) underwent endoscopic clipping immediately after the injury; surgery was not required as a salvage therapy and there were no complications or deaths among these patients. The remaining 34 patients received antibiotics combined with therapeutic fasting and intravenous hydration. Duodenal perforation-related complications depended significantly on IDT (P = 0.0001), treatment modality (P = 0.008), PIS (P = 0.003), and SIS (P = 0.010). The duodenal perforation-related mortality was significantly related to IDT (P = 0.008) and PIS (P = 0.001).
IDT, PIS, and SIS appear to be important prognostic factors following ERCP-related duodenal perforation. Medical therapy can be suggested as an initial treatment strategy for ERCP-related duodenal perforation, and if possible, endoscopic clipping is strongly recommended. However, surgical treatment should be considered if the perforation is not expected to seal spontaneously, or if the continuing leakage causes PIS or SIS.
内镜逆行胰胆管造影（ERCP）相关十二指肠穿孔虽少见，但可导致高死亡率。本研究旨在评估此类事件的临床转归。
本多中心回顾性研究纳入了 2000 年至 2007 年期间六家机构诊断为 ERCP 相关十二指肠穿孔的 59 例患者。我们根据损伤检测时间（IDT）、腹膜刺激征（PIS）、全身炎症反应征（SIS）和治疗方式评估这些患者的 ERCP 相关十二指肠穿孔相关并发症和死亡率。
59 例患者中，41 例（69.5%）接受了药物治疗，18 例（30.5%）接受了手术治疗。接受药物治疗的 5 例患者发生十二指肠穿孔相关死亡（2 例接受了内镜夹闭，3 例接受了手术治疗）。在药物治疗的患者中，7 例（17.1%）在损伤后立即接受内镜夹闭；由于作为挽救性治疗不需要手术，且这些患者无并发症或死亡。其余 34 例患者接受了抗生素联合禁食和静脉补液治疗。十二指肠穿孔相关并发症与 IDT（P = 0.0001）、治疗方式（P = 0.008）、PIS（P = 0.003）和 SIS（P = 0.010）显著相关。十二指肠穿孔相关死亡率与 IDT（P = 0.008）和 PIS（P = 0.001）显著相关。
IDT、PIS 和 SIS 似乎是 ERCP 相关十二指肠穿孔后的重要预后因素。对于 ERCP 相关十二指肠穿孔，药物治疗可作为初始治疗策略，如果可能，强烈推荐内镜夹闭。然而，如果穿孔预计不会自行封闭，或者持续渗漏导致 PIS 或 SIS，则应考虑手术治疗。
