Department of General Surgery, Ege University School of Medicine, Genel Cerrahi Bornova, 35100, Izmir, Turkey.
Department of Gastroenterology, Ege University School of Medicine, Izmir, Turkey.
BMC Gastroenterol. 2022 Aug 14;22(1):385. doi: 10.1186/s12876-022-02466-9.
Perforations related to endoscopic retrograde cholangiopancreatography (ERCP) are rare but life-threatening complications. The treatment of Type-II-periampullary perforations that develop during endoscopic sphincterotomy remains a topic of discussion. This study aimed to evaluate the usefulness of fully covered self-expanding metal stenting (FCSEMS) for treating Type-II perforations.
The files of all patients who underwent the ERCP procedures between January 2015 and October 2021 were retrospectively reviewed; patients with Stapher Type-II perforation were included in the current study. Patients with FCSEMS were classified into two groups: those who underwent FCSEMS and those who were conventionally followed up. Moreover, patients with FCSEMS were classified into two subgroups: those who underwent simultaneous stenting and those who underwent late stenting. Mortality, surgical intervention, percutaneous drainage, length of hospital stay, and inflammatory markers were all compared between the groups.
Of the 9253 patients undergoing ERCP during the study period, 28 patients (0.3%) were found to have Type-II perforation. The mean age of these patients was 67.7 ± 3.9 years, and 15 patients were female. FCSEMS was performed on 19 patients, whereas 9 patients were on conventional follow-up. None of the patients developed mortality. In the conventional follow-up group, one patient required percutaneous drainage and one required surgical intervention. In contrast, none of the patients in the FCSEMS group required additional intervention. At a statistically significant level, the length of hospital stay was found to be shorter in the FCSEMS group. There was no difference in inflammatory markers between the two groups. In nine patients, FCSEMS was performed simultaneously, whereas, in ten patients, FCSEMS was performed later because they required a second intervention. These two subgroups did not differ in terms of outcomes.
FCSEMS is a safe and effective treatment modality for patients with Type-II perforation. Moreover, it can be safely used in patients whose perforations are diagnosed during the ERCP procedure and in patients whose diagnoses are made after the procedure.
内镜逆行胰胆管造影（ERCP）相关穿孔是罕见但危及生命的并发症。内镜下括约肌切开术过程中发生的 II 型壶腹周围穿孔的治疗仍然是一个讨论的话题。本研究旨在评估全覆膜自膨式金属支架（FCSEMS）治疗 II 型穿孔的有效性。
回顾性分析 2015 年 1 月至 2021 年 10 月间行 ERCP 治疗的所有患者的病历资料，纳入研究的患者为 Stapher II 型穿孔。将接受 FCSEMS 治疗的患者分为 FCSEMS 组和常规随访组。同时，FCSEMS 组患者分为即刻支架组和延迟支架组。比较两组患者的死亡率、手术干预、经皮引流、住院时间和炎症标志物。
在研究期间行 ERCP 的 9253 例患者中，发现 28 例（0.3%）患者发生 II 型穿孔。这些患者的平均年龄为 67.7±3.9 岁，女性 15 例。19 例患者接受了 FCSEMS 治疗，9 例患者接受了常规随访。所有患者均未发生死亡。在常规随访组中，1 例患者需要经皮引流，1 例患者需要手术干预。相比之下，FCSEMS 组无患者需要进一步干预。FCSEMS 组患者的住院时间明显更短，且差异具有统计学意义。两组患者的炎症标志物无差异。9 例患者即刻行 FCSEMS，10 例患者因需行二次干预而延迟行 FCSEMS。这两个亚组的结局无差异。
FCSEMS 是治疗 II 型穿孔的安全有效的方法。此外，它可以安全地用于在 ERCP 过程中诊断穿孔的患者和在该过程后诊断穿孔的患者。
