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Management of ERCP-related perforations: outcomes of single institution in Korea.

Authors
Kim, JH; Yoo, BM; Kim, MW; Kim, WH
Citation
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 13(4):728-734, 2009
Journal Title
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
ISSN
1091-255X1873-4626
Abstract
INTRODUCTION: The aim of this study was to analyze clinicoradiologic findings and treatment outcomes of patients with endoscopic retrograde cholangiopancreatography (ERCP)-related perforations. Between May 2003 and November 2007, 2,247 ERCP procedures with or without sphincterotomy were performed at Ajou University Medical Center, Suwon, Korea, and 20 perforations (0.89%) were identified. DISCUSSION: We retrospectively reviewed medical and surgical records of each patient. Of 18 patients, 11 patients (61.1%) underwent nonsurgical management, and seven patients (38.9%) received surgical management. There were no significant differences in age, gender, and laboratory findings between two groups (P > 0.05). The hospital stay was significantly longer in the operative group than that of the conservative group (P < 0.05, respectively). The most common cause of perforation was sphincterotomy (n = 8) in the conservative group whereas scope itself (n = 6) in operative group, showing a significant difference between the two groups (P < 0.05). The retroperitoneal air was most common findings in eight patients (72.7%) of the conservative group, while six (85.7%) patients of the operative group presented with intraperitoneal air, displaying a significant difference in location of air between the two groups (P < 0.05). Most of sphincterotomy-related perforations were managed nonsurgically. However, the scope-related perforations were usually large and required immediate surgery. Moreover, the delayed operation resulted in a longer hospital stay and high morbidity. Therefore, the selective early surgical intervention is suggested when scope-related perforations are discovered.
MeSH terms
AgedCholangiopancreatography, Endoscopic Retrograde/adverse effects*FemaleHumansIntestinal Perforation/etiology*Intestinal Perforation/radiographyIntestinal Perforation/surgeryIntestinal Perforation/therapy*Length of StayMaleMiddle AgedRetrospective StudiesSphincterotomy, Endoscopic/adverse effects*Tomography, X-Ray Computed
DOI
10.1007/s11605-008-0786-2
PMID
19130154
Appears in Collections:
Journal Papers > School of Medicine / Graduate School of Medicine > Surgery
Journal Papers > School of Medicine / Graduate School of Medicine > Gastroenterology
AJOU Authors
김, 지훈유, 병무김, 진홍김, 명욱김, 욱환
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