Management of iatrogenic injuries due to endoscopic sphincterotomy: Surgical or conservative approaches
Keywords: Endoscopic retrograde cholangiopancreatography, complication, duodenum perforation, surgical repair
Objective: The best therapeutic approach for endoscopic retrograde cholangiopancreatography-related perforations remains controversial; while some authors suggest routine conservative management, others advocate mandatory surgical exploration. We aimed to evaluate our clinical experience of perforations during endoscopic sphincterotomy
Material and Methods: A retrospective chart review from January 2010 to October 2015 identified 20 patients with endoscopic retrograde cholangiopancreatography-related perforations. Data collection included demographics, time to diagnosis, type of perforation, treatment strategy, surgical procedure, complications, hospital stay, and outcome. All patients were classified into groups on the basis of radiological and operative findings.
Results: underwent surgical treatment, whereas 15 patients were managed conservatively. The mean time to diagnosis was 7.8 hrs (range: 1 to 36 hrs). In patients who underwent surgical treatment, the types of perforations included type I and III in one patient each and type II in three patients. Surgical procedures included laparoscopic and open cholecystectomy with t-tube drainage in two patients each and primary repair of duodenal injury with hepaticojejunostomy in one patient. Among conservatively managed patients, eight, four, and three had type II, type III, and type IV injuries, respectively. Of these 15 patients, 60% (n=9) underwent percutaneous procedures. The mean length of hospital stay was similar for conservatively and surgically treated patients (12 vs. 12.4 days, respectively, p=0.790). One patient (5%) with type I injury died of multiorgan deficiency.
Conclusion: h close clinical follow-up, medical treatment can be beneficial for most patients, and surgical procedures should be reserved for patients with type I (definite) and type II/III injuries; in patients with these clinical parameters, conservative management will likely be unsuccessful.
This study was presented at the 12th International Congress of the European-African Hepato-Pancreato-Biliary Association, 23rd- 26th of May, 2017, Mainz, Germany.Cite this paper as: Bostancı Ö, Battal M, Yazıcı P, Demir U, Alkım C. Management of iatrogenic injuries due to endoscopic sphincterotomy: Surgical or conservative approaches. Turk J Surg 2018; 34: 24-27.
Ethics committee approval was received for this study from the ethics committee of Şişli Hamidiye Etfal Training and Research Hospital.
Written informed consent was obtained from patients who participated in this study.
Concept - M.B. O.B., P.Y.; Design - O.B., P.Y., M.B.; Supervision - M.B., C.A., U.D.; Resource - P.Y., U.D., O.B.; Materials - P.Y., C.A., O.B.; Data Collection and/or Processing - P.Y., U.D., C.A.; Analysis and/or Interpretation - P.Y., O.B., C.A.; Literature Search - P.Y., O.B., M.B.; Writing Manuscript - O.B., M.B., P.Y.; Critical Reviews - C.A., M.B., O.B.
No conflict of interest was declared by the authors.
The authors declared that this study has received no financial support.