Endoscopic retrograde cholangiopancreatography-related perforation: recommendations from a single institution experience

Background: Endoscopic retrograde cholangiopancreatography (ERCP)-related duodenal perforation is a serious complication associated with high mortality. We aimed to characterize and define improvements for ERCP through a retrospective review of ERCP-related perforations in our institution. Methods: The review of our medical records identified six cases of ERCP-related perforations between March 2003 and March 2013. Associated clinical manifestations and outcomes, perforation types, imaging ERCP-related findings and treatment modalities were analyzed. Results: Between March 2003 and March 2013, 2071 ERCPs were performed, 6 (0.29%) of which resulted in ERCP-related perforations. The perforations localized in one instance to the horizontal part of duodenum, in one case to the bile duct, in one patient to the hepatic duct, and two times a periampullary perforation occurred. Perforation was suspected in 2 patients during the ERCP because of specific radiological findings, and in four patients after ERCP because of subsequent clinical behavior. The latter four perforations were confirmed by computed tomography (CT). The perforation of the horizontal part of duodenum was managed surgically, whereas the remaining five cases were managed conservatively. Conclusion: Successful management of ERCP-related perforation requires a timely diagnosis and vigilant clinical and radiographic monitoring. CT is an important diagnostic modality in ERCP-related perforations.