Lee TH, Bang BW, Jeong JI, Kim HG, Jeong S, Park SM, Lee DH, Park SH, Kim SJ. Primary endoscopic approximation suture under cap-assisted endoscopy of an ERCP-induced duodenal perforation. World J Gastroenterol 2010; 16(18): 2305-2310 [PMID: 20458771 DOI: 10.3748/wjg.v16.i18.2305]
Corresponding Author of This Article
Seok Jeong, MD, Division of Gastroenterology, Department of Internal Medicine, Inha University School of Medicine, 7-206, 3-ga, Sinheung-dong, Jung-gu, Incheon 400-711, South Korea. inos@inha.ac.kr
Article-Type of This Article
Case Report
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World J Gastroenterol. May 14, 2010; 16(18): 2305-2310 Published online May 14, 2010. doi: 10.3748/wjg.v16.i18.2305
Primary endoscopic approximation suture under cap-assisted endoscopy of an ERCP-induced duodenal perforation
Tae Hoon Lee, Byoung Wook Bang, Jee In Jeong, Hyung Gil Kim, Seok Jeong, Seon Mee Park, Don Haeng Lee, Sang-Heum Park, Sun-Joo Kim
Tae Hoon Lee, Sang-Heum Park, Sun-Joo Kim, Division of Gastroenterology, Department of Internal Medicine, Soon Chun Hyang University College of Medicine, Cheonan Hospital, 23-20 Bongmyung-dong, Cheonan 330-721, South Korea
Byoung Wook Bang, Hyung Gil Kim, Seok Jeong, Don Haeng Lee, Division of Gastroenterology, Department of Internal Medicine, Inha University School of Medicine, 7-206, 3-ga, Sinheung-dong, Jung-gu, Incheon 400-711, South Korea
Jee In Jeong, Seon Mee Park, Division of Gastroenterology, Department of Internal Medicine, Chungbuk National University College of Medicine, 48, Gaesin-dong, Heungdeokgu, Cheongju 361-711, South Korea
Author contributions: Lee TH and Jeong S contributed equally to this work; Park SM, Lee DH, Park SH and Kim SJ provided clinical advice; Lee TH, Jeong JI, Bang BW and Kim HG performed the procedure; Park SH and Lee TH designed the case report; Lee TH wrote the paper.
Correspondence to: Seok Jeong, MD, Division of Gastroenterology, Department of Internal Medicine, Inha University School of Medicine, 7-206, 3-ga, Sinheung-dong, Jung-gu, Incheon 400-711, South Korea. inos@inha.ac.kr
Telephone: +82-32-8902548 Fax: +82-32-8902549
Received: January 26, 2010 Revised: March 5, 2010 Accepted: March 12, 2010 Published online: May 14, 2010
Abstract
Duodenal perforation during endoscopic retrograde cholangiopancreatography (ERCP) is a rare complication, but it has a relatively high mortality risk. Early diagnosis and prompt management are key factors for the successful treatment of ERCP-related perforation. The management of perforation can initially be conservative in cases resulting from sphincterotomy or guide wire trauma. However, the current standard treatment for duodenal free wall perforation is surgical repair. Recently, several case reports of endoscopic closure techniques using endoclips, endoloops, or fully covered metal stents have been described. We describe four cases of iatrogenic duodenal bulb or lateral wall perforation caused by the scope tip that occurred during ERCP in tertiary referral centers. All the cases were simply managed by endoclips under transparent cap-assisted endoscopy. Based on the available evidence and our experience, endoscopic closure was a safe and feasible method even for duodenoscope-induced perforations. Our results suggest that endoscopists may be more willing to use this treatment.
