Emori Tomoya, Yamasaki Tomoaki, Itonaga Masahiro, Bamba Shigeki, Kitagawa Koh, Maruyama Hirotsugu, Ueyama Shunichii, Fujita Koichi, Doi Toshifumi, Iemoto Takao, Shiomi Hideyuki, Sawai Yugo, Ogura Takeshi, Shimatani Masaaki, Nakanishi Fumihiko, Uza Norimitsu, Uenoyama Yoshito, Asai Satoshi, Mandai Koichiro, Azuma Shunjiro, Kitano Masayuki, Takenaka Mamoru
Department of Gastroenterology, Wakayama Rosai Hospital, Wakayama, Japan.
Department of Gastroenterology, Osaka City General Hospital, Osaka, Japan.
Gastrointest Endosc. 2025 Jul;102(1):97-105.e3. doi: 10.1016/j.gie.2024.12.018. Epub 2024 Dec 15.
Perforation is a rare but serious adverse event associated with ERCP. There is no consensus to guide clinicians in the management of ERCP-related duodenal perforations, making it difficult to determine whether surgical or endoscopic treatment is optimal. The present study retrospectively evaluated the characteristics and clinical outcomes of patients who experienced ERCP-related duodenal perforations according to the mechanism of injury.
This study evaluated the incidence of ERCP-related duodenal perforations among 51,957 patients who underwent ERCP at 21 tertiary care hospitals in Japan between April 2017 and March 2022. ERCP-related duodenal perforations were categorized according to the Stapfer classification system. Serious adverse events, length of stay (LOS), and mortality associated with ERCP-related duodenal perforations were evaluated according to the mechanism of injury, time of diagnosis, and treatment modality.
Of 51,957 patients who underwent ERCP, 58 (.12%) experienced ERCP-related duodenal perforations. The mean LOS was 27.1 days, and the mortality rate was 2%. LOS (P = .031) and time to healing (P = .009) were significantly shorter in patients who underwent endoscopic than surgical treatment. Multivariate Cox regression analysis showed that endoscopic treatment (P = .017) and intraprocedural diagnosis (P = .019) were independently associated with a good clinical course.
Diagnosing a perforation during the ERCP procedure can prevent serious adverse events. Fluoroscopic and endoscopic images should be carefully reviewed. Endoscopic management should be the treatment of choice for patients diagnosed with perforation during ERCP procedures.
穿孔是与内镜逆行胰胆管造影术（ERCP）相关的一种罕见但严重的不良事件。在ERCP相关十二指肠穿孔的管理方面，尚无共识指导临床医生，这使得难以确定手术治疗还是内镜治疗是最佳选择。本研究根据损伤机制回顾性评估了发生ERCP相关十二指肠穿孔患者的特征和临床结局。
本研究评估了2017年4月至2022年3月期间在日本21家三级医疗机构接受ERCP的51957例患者中ERCP相关十二指肠穿孔的发生率。ERCP相关十二指肠穿孔根据斯塔普费尔分类系统进行分类。根据损伤机制、诊断时间和治疗方式，评估与ERCP相关十二指肠穿孔相关的严重不良事件、住院时间（LOS）和死亡率。
在51957例接受ERCP的患者中，58例（0.12%）发生了ERCP相关十二指肠穿孔。平均住院时间为27.1天，死亡率为2%。接受内镜治疗的患者的住院时间（P = 0.031）和愈合时间（P = 0.009）明显短于接受手术治疗的患者。多变量Cox回归分析表明，内镜治疗（P = 0.017）和术中诊断（P = 0.019）与良好的临床病程独立相关。
在ERCP手术过程中诊断穿孔可预防严重不良事件。应仔细审查荧光镜和内镜图像。对于在ERCP手术过程中被诊断为穿孔的患者，内镜管理应是首选治疗方法。
