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Invited Critique
November 01, 2007

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

Author Affiliations

Copyright 2007 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2007

Arch Surg. 2007;142(11):1065. doi:10.1001/archsurg.142.11.1065

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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