| Abstract [eng] |
Relevance of the study. Even though endoscopic retrograde cholangiopancreatography related perforation is rare, it is a very serious complication, not always detectable and may be life-threatening. The aim of the study. To determine the frequency and clinical manifestation of endoscopic retrograde cholangiopancreatography related perforations in Vilnius University hospital Santaros Klinikos in 2012 – 2019, to analyze what diagnostic and treatment methods were used to manage them and to compare the obtained results with the data of other literature sources. Methods and materials. The retrospective analysis was performed from the database of patients who underwent endoscopic retrograde cholangiopancreatography in Vilnius University hospital Santaros Klinikos from January, 2012 to December, 2019. Hospital records, discharge summaries, intervention protocols were reviewed. Perforation was identified when full-thickness injury to the organ‘s wall was identified. Patients were included in the study based on the inclusion and exclusion criteria when there was an indication that perforation might have occurred. MS Office Excel, R-studio programs were used for statistical data analysis. Data is considered statistically significant when the p-value is < 0.05 and the confidence interval is 95%. Results. Out of 2281 patients, 17 cases of perforation were identified (0.75%). 55.82% of patients were treated in the intensive care unit. Death occurred in 29.41%. Perforations were classified by Stapfer classification system: Type I – duodenal wall perforation (23.5%), Type II – perforation of the periampullary area (11.8%), Type III – perforation of the bile or pancreatic ducts (52.9%), Type IV – retroperitoneal perforation without significant clinical presentation (11.8%). 29.41% of perforations were identified during ERCP, in 52.94% of cases clinical symptoms appeared within the first 24 hours, in 17.65% - after 24 hours. Suspected perforation required observation for 11.8% of cases, endoscopic treatment was performed for 64.7% of patients (36.36% required surgery after that), 23.5% - were operated directly. A total 47.1% of patients underwent surgery: laparoscopic (25%), laparotomic: suturing of the defect (83.33%), necrectomy (16.67%). Conclusions. Perforation during endoscopic retrograde cholangiopancreatography occurs rarely – 0.75%, however the mortality rate is high – 29.41%. Perforations most often manifest by new or intensified abdominal pain in the first 24 hours after intervention. Abdominal and pelvic computed tomography scan is the most effective instrumental imaging test. Endoscopic stenting/clipping of the damaged area is most often used treatment method. Older patient age (≥ 70 years), delayed diagnosis and treatment initiation, developed pancreatitis and sepsis lead to poorer treatment results and increase the risk of patient’s death. |
