RESUMEN
Duodenal perforations are an uncommon adverse event during ERCP. Patients can develop significant morbidity and mortality. Even though surgery has been used to manage duodenal complications, therapeutic endoscopy has seen significant advances. Objective: To compare endoscopic approach with surgical intervention in patients with duodenal perforations post-ERCP. Material and Methods: prospective randomized study in a tertiary center with 23 patients divided in 2 groups. Within 12 hours after the event, the patients underwent endoscopic or surgical approach. Endoscopic approach included closure of the perforation with endoclips and SEMS. Surgical repair included hepaticojejunostomy, suture of the perforation or duodenal suture. The success was defined as closure of the defect. Secondary outcomes included mortality, adverse events, days of hospitalization and costs. Results: The success was 100% in both groups. There was one death in the endoscopic group secondary to sepsis. There was no statistical difference in mortality or adverse events. We noticed statistical difference in favor of the endoscopic group considering shorter hospitalization (4.1 days versus 15.2 days, with p=0.0123) and lower cost per patient (U$14,700 versus U$19,872, with p=0.0103). Conclusions: Endoscopic approach with SEMS and endoclips is an alternative to surgery in large transmural duodenal perforations post-ERCP...
Introducción: Las perforaciones duodenales son un evento adverso poco frecuente durante la CPRE. Los pacientes pueden desarrollar morbilidad y mortalidad significativas. La cirugía se ha utilizado para tratar las complicaciones duodenales, pero la endoscopia terapéutica ha visto avances significativos. Objetivo: comparar abordaje endoscópico con intervención quirúrgica en perforaciones duodenales post CPRE. Materiales y Métodos: estudio prospectivo aleatorizado en un centro terciario con 23 pacientes divididos en 2 grupos. 12 horas después del evento, los pacientes fueron sometidos a tratamiento endoscópico o quirúrgico. El abordaje endoscópico incluyó el cierre de la perforación con endoclips y stent metálico autoexpandible. La reparación quirúrgica incluyó hepaticoyeyunostomía, sutura de la perforación o sutura duodenal. El éxito se definió como el cierre del defecto. Los resultados secundarios incluyeron: mortalidad, eventos adversos, días de hospitalización y costos. Resultados: El éxito fue del 100% en ambos grupos. Hubo una muerte en el grupo endoscópico secundaria a sepsis. No hubo diferencia estadísticamente significativa. Hubo una diferencia estadística a favor del grupo endoscópico en vista de la hospitalización más corta (4,1 días frente a 15,2 días, p=0,0123) y menor costo por paciente (U$ 14 700 frente a U$ 19 872, p=0,0103). Conclusión: El abordaje endoscópico es una alternativa a la cirugía en perforaciones duodenales post CPRE...
Asunto(s)
Humanos , Colangiopancreatografia Retrógrada Endoscópica , Perforación Intestinal , Procedimientos Quirúrgicos del Sistema Digestivo , Estudios ProspectivosRESUMEN
INTRODUCTION: Duodenal perforations are an uncommon adverse event during ERCP. Patients can develop significant morbidity and mortality. Even though surgery has been used to manage duodenal complications, therapeutic endoscopy has seen significant advances. OBJECTIVE: To compare endoscopic approach with surgical intervention in patients with duodenal perforations post-ERCP. MATERIAL AND METHODS: prospective randomized study in a tertiary center with 23 patients divided in 2 groups. Within 12 hours after the event, the patients underwent endoscopic or surgical approach. Endoscopic approach included closure of the perforation with endoclips and SEMS. Surgical repair included hepaticojejunostomy, suture of the perforation or duodenal suture. The success was defined as closure of the defect. Secondary outcomes included mortality, adverse events, days of hospitalization and costs. RESULTS: The success was 100% in both groups. There was one death in the endoscopic group secondary to sepsis. There was no statistical difference in mortality or adverse events. We noticed statistical difference in favor of the endoscopic group considering shorter hospitalization (4.1 days versus 15.2 days, with p=0.0123) and lower cost per patient (U$14,700 versus U$19,872, with p=0.0103). CONCLUSIONS: Endoscopic approach with SEMS and endoclips is an alternative to surgery in large transmural duodenal perforations post-ERCP.