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ERCP-related perforation: an analysis of operative outcomes in a large series over 12 years
- Source :
- Surgical Endoscopy; January 2020, Vol. 34 Issue: 1 p77-87, 11p
- Publication Year :
- 2020
-
Abstract
- Background: Perforation is a rare but serious adverse event of endoscopic retrograde cholangiopancreatography (ERCP). The aim of this study was to determine the predictors of morbidity and mortality after surgical management of ERCP-related perforation (EP). Methods: The records of patients with EP requiring surgical intervention at a tertiary referral center in a 12-year period (2004–2016) were retrospectively analyzed for demography, indications for ERCP, risk factors, timing and type of surgical repair, post-operative course, hospital stay, and outcome. Multiple logistic regression was used to identify the parameters predicting survival. Results: Of 25,300 ERCPs, 380 (1.5%) had EP. Non-operative management was successful in 330 (86.8%) patients. 50 (13.2%) patients were operated for EP. Out of 50, the perforation was detected during ERCP (intra-procedure) in 32 patients (64%). In 30 patients (60%), the surgery was performed within 24 h of ERCP. Twenty patients underwent delayed surgery (after 24 h of ERCP) following the failure of initial non-operative management. The delayed surgery after an unsuccessful medical treatment had a detrimental effect on morbidity, mortality and hospital stay. Post-operative duodenal leak was the only independent predictor of 90-day mortality (p= 0.02, OR = 9.1, 95% CI 1.52–54.64). Addition of T-tube duodenostomy (TTD) to the primary repair for either type I or type II perforations increased post-operative duodenal leak (type I, p= 0.048 and type II; p= 0.001) and mortality (type I, p= 0.009 and type II, p= 0.045). Conclusion: Although EP is a rare event, it has a serious impact on morbidity and mortality. Delaying of surgery following failed non-operative management worsens the prognosis. Addition of TTD to the repair is not helpful in these patients.
Details
- Language :
- English
- ISSN :
- 09302794 and 14322218
- Volume :
- 34
- Issue :
- 1
- Database :
- Supplemental Index
- Journal :
- Surgical Endoscopy
- Publication Type :
- Periodical
- Accession number :
- ejs49175307
- Full Text :
- https://doi.org/10.1007/s00464-019-06733-x