ERCP subsequent to retroperitoneal perforation caused by endoscopic sphincterotomy

BACKGROUND: Perforation occurs after endoscopic sphincterotomy in 0.4% of cases. With recognition of a perforation, the procedure usually is aborted and further attempts at ERCP are thought to be precluded by the complication. The aim of this study was to determine the timing and the outcome of ERCP after retroperitoneal perforation caused by endoscopic sphincterotomy when the initial ERCP was incomplete. METHODS: A total of 1787 patients underwent endoscopic sphincterotomy during a period of 29 months. A type II duodenal perforation was recognized in 15 patients, whereupon the ERCP, including further intervention, was halted. Eight patients agreed to undergo a second therapeutic ERCP to complete the treatment of the primary disease. OBSERVATIONS: Therapeutic ERCP was repeated in all patients from 11 to 15 days after the perforation. Treatment was successfully completed in all patients without complication. CONCLUSIONS: Therapeutic ERCP may be repeated and has a high success rate in patients who sustain a perforation caused by endoscopic sphincterotomy.