Tarallo Mariarita, Crocetti Daniele, Coppola Alessandro, Iannone Immacolata, Lamazza Antonietta, Sapienza Paolo, Fiori Enrico
Department of Surgery, Sapienza University of Rome, Rome 00161, Italy.
World J Gastrointest Surg. 2025 Jul 27;17(7):107385. doi: 10.4240/wjgs.v17.i7.107385.
Endoscopic retrograde cholangiopancreatography (ERCP) plays a vital role in managing biliary and pancreatic diseases but carries a risk of severe complications that may require surgical intervention. This review focuses on the surgical management of key ERCP-related complications: Post-sphincterotomy bleeding, perforations, stent migration-induced perforations, and Dormia basket impaction. Although many complications can be managed endoscopically, surgery remains essential in refractory cases or when less invasive methods fail. Post-sphincterotomy bleeding, although often controlled endoscopically, may necessitate surgical ligation when hemorrhage persists. Perforations, classified by anatomical type, require tailored surgical approaches - primary repair for type I and biliary diversion with defect closure for types II and III. Stent migration-induced perforations, which may lead to peritonitis or abscess formation, often require surgery due to their variable clinical presentation and the lack of standardized management guidelines. Dormia basket impaction, although rare, may require advanced endoscopic techniques or laparoscopic retrieval if conservative measures prove ineffective. Early recognition, multidisciplinary collaboration, and individualized treatment strategies are pivotal in reducing morbidity and mortality. This review underscores evolving surgical approaches, emphasizing the importance of timely, patient-specific decisions to improve outcomes in severe ERCP-related complications.
内镜逆行胰胆管造影术（ERCP）在胆道和胰腺疾病的治疗中起着至关重要的作用，但存在严重并发症的风险，可能需要手术干预。本综述重点关注ERCP相关关键并发症的手术治疗：括约肌切开术后出血、穿孔、支架移位导致的穿孔以及多尔米亚网篮嵌顿。尽管许多并发症可通过内镜处理，但在难治性病例或微创方法失败时，手术仍然至关重要。括约肌切开术后出血，尽管通常可通过内镜控制，但出血持续时可能需要手术结扎。穿孔根据解剖类型分类，需要采用定制的手术方法——I型进行一期修复，II型和III型进行胆道转流并关闭缺损。支架移位导致的穿孔可能导致腹膜炎或脓肿形成，由于其临床表现多样且缺乏标准化管理指南，往往需要手术治疗。多尔米亚网篮嵌顿虽然罕见，但如果保守措施无效，可能需要先进的内镜技术或腹腔镜取出。早期识别、多学科协作和个体化治疗策略对于降低发病率和死亡率至关重要。本综述强调了不断发展的手术方法，强调了及时做出针对患者的决策以改善严重ERCP相关并发症预后的重要性。
