A SURGICALLY-COMPROMISED SITUATION: ERCP-RELATED COMPLICATIONS

Yıl 2018, Cilt: 51 Sayı: 1, 14 - 19, 30.03.2018

Aziz Mutlu Barlas

Öz

Background: In this retrospective study, an evaluation was made
of ERCP-related perforations and necrotizing pancreatitis that required
surgical intervention.

Methods:
A total of 1439
ERCP procedures were performed by gastroenterologists and 12 complications that
required surgical intervention were identified (0.8%). All of the
cases presented in this study were primarily managed conservatively in the Gastroenterology
Department and were evaluated by the surgeons when signs and symptoms
deteriorated.

Results: Patient age was
mean 55.5±17.3 years. The mean
time from ERCP to surgery was 3.92 days (0-14 days). Of the 12 patients, 6 (50%)
died postoperatively. No statistically significant difference was determined between
the surviving and not surviving groups in respect of patient age or the mean
time from ERCP to operation. The operational technique was decided during the
surgery depending on the extent of the perforation and the condition of the
peritoneum. The correlation between diagnosis and type of operative procedure was
similar in both groups.

Conclusions: There is no consensus on the surgical management of
ERCP-related complications which might result in high mortality rates despite
full-care management. Therefore, the main objective of departments dealing with
ERCP procedures should be to reduce the risk of ERCP-related complications to a
minimum.

Anahtar Kelimeler

ERCP; complication; hepatobiliary surgery; perforation; necrotizing pancreatitis; duodenum

Kaynakça

• 1. Mallery JS, Baron TH, Dominitz JA, Goldstein JL, Hirota WK, Jacobson BC et al. Complications of ERCP. Gastrointest Endosc. 2003;57:633-638.
• 2. Anderson MA, Fisher L, Jain R, Evans JA, Appalaneni V, Ben-Menachem T et al. Complications of ERCP. Gastrointest Endosc. 2012;75:467-473.
• 3. Döbrönte Z. Endoscopic Retrograde Cholangiopancreatography (ERCP) Related Acute Pancreatitis. Acute Pancreatitis. Prof. Luis Rodrigo (Ed.), ISBN: 978-953-307-984-4, InTech, 2012. Available from: http://www.intechopen.com/ books/ acute-pancreatitis/ endoscopic-retrograde-cholangiopancreatography-ercprelated-acute pancreatitis.
• 4. Machado NO. Management of duodenal perforation post-endoscopic retrograde cholangiopancreatography. When and whom to operate and what factors determine the outcome? A review article. J.O.P. 2012;13:18-25.
• 5. Howard TJ, Tan T, Lehman GA, Sherman S, Madura JA, Fogel E et al. Classification and management of perforations complicating endoscopic sphincterotomy. Surgery 1999;126: 658-663.
• 6. Park SM. Recent advanced endoscopic management of endoscopic retrograde cholangiopancreatography related duodenal perforations. Clin Endosc. 2016;49:376-382.
• 7. Freeman ML. Complications of endoscopic retrograde cholangiopancreatography: avoidance and management. Gastrointest Endosc Clin N Am. 2012;22:567-586.
• 8. Assalia A, Suissa A, Ilivitzki A, Mahajna A, Yassin K, Hashmonai M et al. Validity of clinical criteria in the management of endoscopic retrograde cholangiopancreatography related duodenal perforations. Arch Surg. 2007;142:1059-1064.
• 9. Alfieri S, Rosa F, Cina C, Tortorelli AP, Tringali A, Perri V et al. Management of duodeno-pancreato-biliary perforations after ERCP: outcomes from an Italian tertiary referral center. Surg Endosc. 2013;27:2005-2012.
• 10. Mao Z, Zhu Q, Wu W, Wang M, Li J, Lu A et al. Duodenal perforations after endoscopic retrograde cholangiopancreatography: experience and management. J Laparoendosc Adv Surg Tech A. 2008;18:691-695.
• 11. Knudson K, Raeburn CD, McIntyre RC Jr, Shah RJ, Chen YK, Brown WR et al. Management of duodenal and pancreaticobiliary perforations associated with periampullary endoscopic procedures. Am J Surg. 2008;196:975-981.
• 12. Fatima J, Baron TH, Topazian MD, Houghton SG, Iqbal CW, Ott BJ et al. Pancreaticobiliary and duodenal perforations after periampullary endoscopic procedures: diagnosis and management. Arch Surg. 2007;142:448-454.
• 13. Sarli L, Porrini C, Costi R, Regina G, Violi V, Ferro M et al. Operative treatment of periampullary retroperitoneal perforation complicating endoscopic sphincterotomy. Surgery 2007;142:26-32.
• 14. Scarlett PY, Falk GL. The management of perforation of the duodenum following endoscopic sphincterotomy: a proposal for selective therapy. ANZ J Surg. 1994;64:843-846.
• 15. Avgerinos DV, Llaguna OH, Lo AY, Voli J, Leitman IM. Management of endoscopic retrograde cholangiopancreatography: related duodenal perforations. Surg Endosc. 2009;23:833-838.
• 16. Preetha M, Chung YF, Chan WH, Ong HS, Chow PK, Wong WK et al. Surgical management of endoscopic retrograde cholangiopancreatography-related perforation. ANZ J Surg. 2003;73:1011–1014.
• 17. Koc B, Bircan HY, Adas G, Kemik O, Akcakaya A, Yavuz A et al. Complications following endoscopic retrograde cholangiopancreatography: minimal invasive surgical recommendations. PLoS One 2014;9:e113073.