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Invited Critique |

Validity of Clinical Criteria in the Management of Endoscopic Retrograde Cholangiopancreatography–Related Duodenal Perforations—Invited Critique

Henry A. Pitt, MD
Arch Surg. 2007;142(11):1065. doi:10.1001/archsurg.142.11.1065.
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Assalia and colleagues described 22 patients with ERCP-related DPs in a series of 3104 procedures (0.7%) performed during a 7½-year period. Clinical and radiologic criteria were developed and were applied preoperatively to guide management. Early diagnosis was established in 20 patients (91%). Twenty patients (91%) were initially treated nonoperatively, whereas 2 with scope-related lateral duodenal intraperitoneal perforations were treated successfully with early surgery. Two additional patients underwent late salvage surgery, and 1 of these patients eventually died of sepsis. Three patients were treated endoscopically using an indwelling (n = 2) or a nasobiliary (n = 1) stent. One patient was treated with a percutaneous biliary stent. Thus, 14 patients (64%) were treated without a surgical, endoscopic, or percutaneous procedure, although 5 of these patients underwent a second therapeutic endoscopic procedure 7 to 14 days after the perforation.

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