XXXX after periampullary endoscopic procedures: diagnosis and management.

@entity1 @entity158 @entity2877 @entity491 @entity9317
OBJECTIVE: To review our experience with management of pancreaticobiliary and duodenal (PB/D) perforations after periampullary endoscopic interventions. Although @entity9317 after periampullary endoscopic procedures are rare, their management has not been well described. @entity1 : Individuals who experienced @entity9317 . MAIN OUTCOME MEASURES: Comorbidities, interventions performed, mechanism/site of perforation, management, and hospital morbidity/mortality. RESULTS: Seventy-five perforations (0.6%) occurred in 12,427 procedures; 20 perforations (27%) occurred during biliary stricture dilatation, 18 (24%) during diagnostic endoscopic retrograde cholangiopancreatography, and 15 (20%) during management of @entity2877 . Perforations were caused by guidewire insertion in 24 @entity1 (32%), sphincterotomy in 11 (15%), passage of the endoscope in 8 (11%), or stent migration in 7 (9%) and were identified during the index procedure in 45 @entity1 (60%). Delayed presentations included @entity158 in 33 @entity1 (44%), @entity491 in 26 (35%), and/or fever in 13 (17%) and were diagnosed using computed tomography in 19 @entity1 (25%) and abdominal radiography in 10 (13%); 9 cases (12%) were diagnosed more than 24 hours after the procedure. Indications for operative treatment were gaping duodenal perforations and perforations in @entity1 with surgically altered anatomy. Indications for nonoperative management included contained bile duct perforations and focal duodenal perforations. Management was nonoperative in 53 @entity1 (71%) and operative in 22 (29%). @entity1 with duodenal perforations, higher American Society of Anesthesia status (P<.01 each), and older age (mean +/- SEM, 65 +/- 4 vs 55 +/- 2 years; P = .02) were more likely to require operative management. Hospital stay (mean +/- SEM, 16 +/- 4 vs 4 +/- 1 days; P<.05) and mortality (13% vs 4%; P<.05) were greater in operative @entity1 (P<.05 each). CONCLUSIONS: Most (70%) @entity9317 secondary to periampullary endoscopic interventions can be managed nonoperatively. Most biliary perforations can be managed nonoperatively; a requirement for operative treatment increases the mortality rate.
