Proposal of an endoscopic retrograde cholangiopancreatography-related perforation management guideline based on perforation type.
10.4174/jkss.2012.83.4.218
- Author:
Wooil KWON
1
;
Jin Young JANG
;
Ji Kon RYU
;
Yong Tae KIM
;
Yong Bum YOON
;
Mee Joo KANG
;
Sun Whe KIM
Author Information
1. Department of Surgery, Seoul National University College of Medicine, Seoul, Korea. jangjy4@gmail.com
- Publication Type:Original Article
- Keywords:
Endoscopic retrograde cholangiopancreatography;
Intestinal perforation;
Guideline;
Algorithms
- MeSH:
Cholangiopancreatography, Endoscopic Retrograde;
Consensus;
Hospital Costs;
Hospital Mortality;
Humans;
Intestinal Perforation;
Jejunum;
Length of Stay;
Peritonitis;
Retrospective Studies;
United States
- From:Journal of the Korean Surgical Society
2012;83(4):218-226
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: Consensus for endoscopic retrograde cholangiopancreatography (ERCP) related perforation management is lacking. We aimed to identify candidate patients for conservative management by examining treatment results and to introduce a simple, algorithm-based management guideline. METHODS: A retrospective review of 53 patients with ERCP-related perforation between 2000 and 2010 was conducted. Data on perforation site (duodenum lateral wall or jejunum, type I; para-Vaterian, type II), management method, complication, mortality, hospital stay, and hospital cost were reviewed. Comparative analysis was done according to the injury types and management methods. RESULTS: The outcome was greater in the conservative group than the operative group with shorter hospital stay (20.6 days vs. 29.8 days, P = 0.092), less cost (10.6 thousand United States Dollars [USD] vs. 19.9 thousand USD, P = 0.095), and lower morbidity rate (22.9% vs. 55.6%, P = 0.017). Eighty-one percent (17/21) of type I injuries were operatively managed and 96.9% (31/32) of type II injuries were conservatively managed. Between the types, type II showed better results over type I with shorter hospital stay (19.3 days vs. 30.6 days, P = 0.010), less cost (9.5 thousand USD vs. 20.1 thousand USD, P = 0.028), and lower complication rate (18.8% vs. 57.1%, P = 0.004). There was no difference in mortality. CONCLUSION: Type II injuries were conservatively manageable and demonstrated better outcomes than type I injuries. The management algorithm suggests conservative management in type II injuries without severe peritonitis or unsolved problem requires immediate surgical correction, including operative management in type I injuries unless endoscopic intervention is possible. Conservative management offers socio-medical benefits. Conservative management is recommended in well-selected patients.
