Central Surgical AssociationClassification and management of perforations complicating endoscopic sphincterotomy☆
Section snippets
Methods
Consecutive patients with ERCP/ES perforations between January 1994 and July 1998 were retrospectively reviewed. In a series of 6040 ERCPs, 2874 ESs were performed. In this population, 39 perforations (0.6%) were identified from the Indiana University ERCP complication database. This database was cross-referenced through our medical records data system by querying using the ICD9 code 998.2 (accidental puncture or laceration during a procedure) as both the primary or secondary diagnosis and
Results
Patients were categorized into 3 groups on the basis of the type of injury: guidewire perforation of the duct (group I), periampullary perforation (group II), or duodenal perforation remote from the papilla (group III). Patient demographics and associated illnesses are listed in Table I. The indications for ES and the type of procedure performed are reported in Table II. All patients (n = 14 patients) with guidewire perforation (group I) were identified immediately during the procedure by the
Discussion
Perforations during ERCP/ES may occur either during cutting of the Vaterian sphincter, cannulation of the bile or pancreatic duct with a guidewire or sharp tip catheter, or by the endoscope during positioning and manipulation (Fig 1). Some of the ambiguity surrounding the appropriate treatment of ES perforations is in not
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Reprint requests: Thomas J. Howard, MD, Associate Professor of Surgery, Emerson Hall #523, 545 Barnhill Dr, Indianapolis, IN 46202.