Management of endoscopic retrograde cholangiopancreatography (ERCP)-related perforations in a tertiary care centre in North-East India

Background and aims: Endoscopic retrograde cholangiopancreatography (ERCP) related perforations are rare complications but are associated with significant morbidity and mortality. The purpose of this retrospective study was to evaluate the management and outcomes of these perforations. Methods: The study was conducted from January 2016 to January 2020 at a tertiary care centre in Northeast India. We reviewed the medical records and collected data on patients with ERCP induced perforations. We analysed the type of injury, management and outcomes. Results: A total of 450 ERCPs were performed at our centre during the study period. Eleven patients (2.4%) developed ERCP related perforations. Two patients had type I injury, identified during ERCP and managed by urgent surgery. Three patients with type II injury were managed conservatively. One patient with type III injury was detected intra-operatively on laparoscopy for planned laparoscopic cholecystectomy, which was organised by placing subhepatic and pelvic drains. Five patients with type IV injury were also managed conservatively. Conclusion: Type I injuries require immediate surgical or endoscopic closure whenever possible. An
initial conservative approach to small perforation for type II injury may be appropriate, but surgical consultation and careful observation is mandatory. Type III and IV injuries almost always improve after conservative treatment.

Keywords: Endoscopy; perforation; emergency surgery; hepatopancreaticobiliary diseases.