Système gastro-intestinal et digestif

Abstrait

Sphincterotomy Related Perforations Diagnosed by CT: Incidence, Risk Factors and Outcome

Michael Shapiro, Laurian Copel, Dov Abramowich, Eitan Scapa, Haim Shirin, Efrat Broide

Duodenal perforation occurring during endoscopic retrograde cholangiopancreatography (ERCP) has been shown to cause high mortality. For assessment the incidence and risk factors of perforation after ERCP and determine the clinical outcome, an abdominal computerized tomography (CT) scan was performed in 180 patients undergoing therapeutic ERCP during three years. Demographic data, type of procedure (classical or pre-cut papillotomy), type of perforation (intra or retroperitoneal), laboratory tests, treatment, and outcome were evaluated.

Retroperitoneal perforation was detected in 21 patients (11.7%). Of these in four patients, perforation was retro and also intraperitoneal. Five patients in the perforation group died, two due to the procedure and three from unrelated causes. Patients who died were older than patients who remained alive. None of the patients with a retroperitoneal perforation underwent surgery, but one died from sepsis. Serum bilirubin levels were significantly higher in patients with perforation. Difficult or unsuccessful cannulation of the CBD and pre-cut papillotomy were found to be risk factors for perforation.

We suggest to perform an abdominal CT soon after therapeutic ERCP in elderly patients with high bilirubin levels in whom the ERCP was difficult or unsuccessful, or pre-cut papillotomy was needed. In patients with a retroperitoneal perforation, closer monitoring for signs of sepsis and/or peritonitis is required.