| Background:Endoscopic retrograde cholangiopancreatography(ERCP)has become the preferred diagnostic and therapeutic means for many biliary and pancreatic diseases.However,ERCP can also cause a series of complications,including bleeding,infection,pancreatitis and perforation.ERCP-related perforation is relatively rare,but there is a high risk of death.If the risk factors can be fully predicted before surgery,the risk of perforation can be greatly reduced.At present,there is no consensus on conservative(endoscopic)or surgical treatment for perforation in China and abroad.Therefore,in-depth analysis of the risk factors leading to perforation and the selection of the most appropriate treatment for patients with perforation are crucial.Objective:The risk factors for different perforations were analyzed,and the clinical outcomes were discussed according to different treatment methods,so as to guide clinical treatment and improve prognosis.Methods:The patients who underwent ERCP in the inpatient department or digestive endoscopy center of the First Affiliated Hospital of Nanchang University from January 1,2007 to February 28,2021 were retrospectively analyzed.General information(age,gender,underlying diseases,history of surgery,clinical manifestations,laboratory and imaging examinations),surgical data(indications,mode of operation,causes and diameter of perforation),diagnostic time,treatment data(medication,endoscopic and surgical treatment)and clinical results(average length of hospital stay,hospital mortality)were collected.Descriptive statistical method was used to evaluate the demographic characteristics,causes of perforation,risk factors and treatment methods of patients.Results:There were 67 cases of perforation in 25608 ERCP operations,38 females and29 males,with an average age of 64.2 years(35-90 years).Perforation occurs mainly around the duodenum and duodenal papilla.21 cases were caused by endoscopic injury(17 cases of duodenum,1 case of input loop,1 case of fundus of stomach,1 case of cardia,1 case of jejunum),19 cases were caused by sphincterotomy,10 cases were caused by stent displacement,8 cases were caused by papillary balloon dilatation,2 cases were caused by basket injury,1 case was caused by repeated intubation,1 case was caused by biliary stricture and dilatation,and 5cases were unknown.28 patients(41.8 %)had a history of abdominal surgery,including 3 cases of subtotal gastrectomy.21 cases(31.3 %)had periampullary diverticulum,of which 10 cases(14.9 %)underwent nipple pre-incision.Only 4(6.0 %)of the 67 patients with ERCP perforation underwent surgical treatment,and they were discharged successfully.63 cases(94.0 %)were treated by endoscopy,and 60 cases of 63 patients were successfully treated by endoscopy.One patient with duodenal perforation died of postoperative secondary septic shock.Acute diffuse peritonitis and abdominal infection occurred in one case of periampullary perforation and one case of duodenal perforation caused by bile duct stent displacement which required automatic discharge in critical condition.The average length of stay was 14.1 days(4-77).A total of 1(1.5 %)patient died during hospitalization.Conclusions:1.Insertion and intubation perforation : history of abdominal surgery(Billroth Ⅱ–type),periampullary diverticulum,operating factors(sphincterotomy,papillary balloon dilatation)may be risk factors for perforation.It is easier to diagnose perforation during ERCP,so any possible perforation should be checked at the end of each endoscopic operation.2.Scaffold displacement perforation : linear biliary stent may be more prone to perforation caused by stent displacement.3.The majority of perforation can be early endoscopic closure,postoperative with active drug therapy can recover.A few perforations with failed closur e should be treated surgically as early as possible. |
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