经内镜逆行胰胆管造影术后StapferⅠ型十二指肠穿孔4例临床分析

正经内镜逆行胰胆管造影(ERCP)已经成为治疗胆胰系统疾病的一线微创诊疗方法,它也是目前消化内镜技术中难度最大和风险最高的操作之一,相关并发症时有发生。十二指肠穿孔是ERCP最严重的并发症,术中穿孔发生率0.08%～0.6%,病死率8%～23%[1],需要迅速作出诊断和及时治疗,以改善患者预后。本文回顾分析西部战区总医院消化内科发生的ERCP相关十二指肠穿孔4例(均为StapferⅠ型),3例经内镜下治疗,1例行外科手术,根据临床资料结合文献总结合报告如下。     

经内镜逆行胰胆管造影术中特殊胆总管穿孔1例

本文报道1例经内镜逆行胰胆管造影术中特殊胆总管穿孔病例,该病例在穿孔部位、分型、引起胆总管穿孔的器械等方面,均属罕见。     

经内镜逆行胰胆管造影相关穿孔6例临床分析

目的探讨经内镜逆行胰胆管造影(ERCP)并发消化道穿孔的原因、诊疗原则和预防。方法收集2009年1月至2013年12月上海市嘉定区中心医院施行ERCP术后并发穿孔病例,回顾分析穿孔原因、分型、诊疗经过。结果 4年间实施ERCP 459例,6例发生穿孔,发生率1.3%。依据穿孔原因,插镜导致穿孔3例,插入导管或乳头切开2例,导丝或网篮导致穿孔1例。保守治疗2例,均顺利出院;手术治疗4例,1例死亡。结论 ERCP相关穿孔依据穿孔原因、分型制订个体化治疗可获得较理想的预后。操作时精细、谨慎,特别对于高龄或有上腹部手术史者动作轻柔,可降低穿孔的发生率。     

磁共振胰胆管造影术与经内镜逆行胰胆管造影术诊断阻塞性黄疸的价？…

目的：比较磁共振胰胆管造影术（ＭＲＣＰ）与经内镜逆行胰胆管造影术（ＥＲＣＰ）对阻塞性黄疸的诊断价值。方法：５５列阻塞性黄疸患者分别行ＭＲＣＰ和ＥＲＣＰ,其中１例行ＥＲＣＰ失败改行经皮肝胆管造影术（ＰＴＣ）。ＭＲＣＰ采用重Ｔ２加权及超快速自旋回波水成像技术进行,ＥＲＣＰ和ＰＴＣ按常规方法进行。结果：ＭＲＣＰ与ＥＲＣＰ（或ＰＴＣ）总的诊断准确率分别为９０．９％（５０／５５）和９８．２％（５４／５５）,     

经内镜逆行胰胆管造影术后胰腺炎防治的研究进展

经内镜逆行胰胆管造影术(ERCP)是目前诊治胆胰疾病的一项重要技术,术后胰腺炎(PEP)是其最常见的并发症。自ERCP诞生以来,PEP防治便成为国际性研究焦点,近年来研究成果层出不穷,在危险因素、药物预防、预防性胰管支架置入等方面取得诸多进展。但研究结论不甚一致,仍需要临床进一步研究证实。     

经内镜逆行胰胆管造影术教育与培训研究进展

经内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography, ERCP)是胆胰疾病诊断及治疗的重要手段。ERCP教育与培训为推广和普及ERCP技术做出巨大贡献,但目前的ERCP培训模式仍以传统的师徒模式为主,缺乏标准化的ERCP教育与培训模式,近年来ERCP模拟器在培训中有所应用,手把手培训也有更多的临床研究报道。本文对目前ERCP教育培训模式及方法的研究现状与进展进行总结。     

预防内镜逆行胰胆管造影术后胰腺炎的探讨

目的 评价西咪替丁对经内镜逆行胰胆管造影（ＥＲＣＰ）术后高淀粉酶血症及急性胰腺炎的预防作用。方法 将４１４患者随机分为Ａ、Ｂ、Ｃ三组,Ａ组（１５８例）分别于术前一日、 当日及术后一日给予西咪替丁（８００ｍｇ／ｄ,静脉滴注）,Ｂ组（１４７例０分别于术前３０ｍｉｎ及术后４ｈ内给予生长抑素类似物奥曲肽０．１ｍｇ皮下注射,Ｃ组（１０９例）给予安慰剂,术前、术后３ｈ及２４ｈ检测血清淀粉酶（正常参考值１０～１     

经内镜逆行胰胆管造影术患者的护理

随着内镜技术的发展和内镜器械的改进，消化道疾病的诊疗技术发生了划时代的变革，内镜治疗逐渐成为胃肠和胆胰疾病的主要治疗方法之一。现将我院自1995年6月至2002年6月行逆行胰胆管造影(ERCP)108例病人护理情况总结如下。     

儿童经内镜逆行胰胆管造影术61例临床分析

目的 探讨儿童经内镜逆行胰胆管造影术（endoscopic retrograde cholangiopancreatography,ERCP）的主要适应证及主要并发症的危险因素。方法 2010—2017年于北京友谊医院内镜中心行ERCP诊治的年龄≤14岁胆胰疾病患儿61例,共行ERCP操作101例次,回顾分析行ERCP的病因、麻醉方式、操作成功率、并发症发生率等情况,对主要并发症的影响因素先后行单因素分析和多因素Logistic回归分析。结果 101例次操作中成功97例次,成功率为96.0%。慢性胰腺炎（68.3%,69/101）、胰腺分裂（11.9%,12/101）、胆管结石（8.9%,9/101）分别占适应证的前3位。总体并发症发生率为32.7%（33/101）,以高淀粉酶血症（13.9%,14/101）及术后胰腺炎（13.9%,14/101）最常见。多因素Logistic回归分析发现慢性胰腺炎与高淀粉酶血症及术后胰腺炎呈负相关（P＜0.01,OR=0.020,95%CI：0.002～0.160）,而胰腺分裂（P＜0.01,OR=7.4,95%CI：1.4～37.9）、胰管插管（P＜0.01,OR=79.7,95%CI：6.5～972.6）为高淀粉酶血症及术后胰腺炎的独立危险因素。结论 儿童行ERCP以慢性胰腺炎为主要适应证,总体操作成功率较高,但相关并发症发生率不低,尤其在一些特殊患儿（如胰腺分裂）的操作过程中应当引起重视。     

经内镜逆行胰胆管造影术后并发症的防治

经内镜逆行胰胆管造影术(ERCP)已从单纯的诊断技术发展为胆胰疾病的首选治疗措施,但其并发症在一定程度上不可避免,严格掌握ERCP适应证和禁忌证、加强术者的操作技术和术中的准确判断与处理,以及相关药物的合理使用是术后并发症预防和治疗的关键。     

ERCP术中并发上消化道穿孔11例

目的:探讨内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)并发上消化道穿孔的原因及穿孔的处理防治.方法:收集整理南京市鼓楼医院近3年(2008-08-31/2011-08-31)ERCP术中并发上消化道穿孔患者2399例,依据一定标准进行穿孔原因诊断分析,并针对患者的实际情况采取保守治疗和手术治疗相结合的方法进行穿孔治疗.结果:2399例ERCP术中发现上消化道穿孔共11例,发生率0.46%(其中食管穿孔1例,贲门口穿孔1例,十二指肠球部穿孔2例,十二指肠降部及乳头周围穿孔5例,毕Ⅱ式胃术后穿孔2例).11例上消化道穿孔中7例为保守治疗成功,4例为手术治疗成功.结论:ERCP并发上消化道穿孔原因较多,主要为医源性,处置方法是在早期发现的基础上,采取保守治疗能取得良好的效果.     

Primary endoscopic approximation suture under cap-assisted endoscopy of an ERCP-induced duodenal perforation

Duodenal perforation during endoscopic retrograde cholangiopancreatography(ERCP) is a rare complication,but it has a relatively high mortality risk.Early diagnosis and prompt management are key factors for the successful treatment of ERCP-related perforation.The management of perforation can initially be conservative in cases resulting from sphincterotomy or guide wire trauma.However,the current standard treatment for duodenal free wall perforation is surgical repair.Recently,several case reports of endosco...     

Endoscopic treatment of duodenal fistula after incomplete closure of ERCP-related duodenal perforation

Endoscopic retrograde cholangiopancreatography(ERCP)is an important diagnostic and therapeutic modality for various pancreatic and biliary diseases.The most common ERCP-induced complication is pancreatitis,whereas hemorrhage,cholangitis,and perforation occur less frequently.Early recognition and prompt treatment of these complications may minimize the morbidity and mortality.One of the most serious complications is perforation.Although the incidence of duodenal perforation after ERCP has decreased to1.0%,severe cases still require prolonged hospitalization and urgent surgical intervention,potentially leading to permanent disability or mortality.Surgery remains the mainstay treatment for perforations of the luminal organs of the gastrointestinal tract.However,evidence from case reports and case series support a beneficial role of endoscopic clipping in the closure of these defects.Duodenal fistulas are usually a result of sphincterotomies,perforated duodenal ulcers,or gastrectomy.Other causative factors include Crohn's disease,trauma,pancreatitis,and cancer.The majority of duodenal fistulas heal with nonoperative management.Those that fail to heal are best treated with gastrojejunostomy.Recently proposed endoscopic approaches for managing gastrointestinal leaks caused by fistulas include fibrin glue injection and positioning of endoclips.Our patient developed a secondary persistent duodenal fistula as a result of previous incomplete closure of duodenal perforation with hemoclips and an endoloop.The fistula was successfully repaired by additional clipping and fibrin glue injection.     

Endoscopic fibrin sealant closure of duodenal perforation after endoscopic retrograde cholangiopancreatography

Traditionally, perivaterian duodenal perforation can be managed conservatively or surgically. If a large volume of leakage results in fluid collection in the retroperitoneum, surgery may be necessary. Our case met the surgical indication for perivaterian duodenal perforation after endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and endoscopic papillary balloon dilatation. The patient developed a retroperitoneal abscess after the procedures, and a perivaterian perforation was suggested on computed tomography (CT). CT-guided abscess drainage was performed immediately. We unsuccessfully attempted to close the perforation with hemoclips initially. Subsequently, we used fibrin sealant (Tisseel) injection to occlude the perforation. Fibrin sealant injections have been previously used during endoscopy for wound closure and fistula repair. Based on our report, fibrin sealant injection can be considered as an alternative method for the treatment of ERCP-related type II perforations.     

Temporary FC-SEMS for type II ERCP-related perforations: a case series from two referral centers and review of the literature*

Background and aim: Some case reports have shown that fully covered self-expandable metal stents (FC-SEMS) are effective in cases of Stapfer Type II perforation as rescue treatment. The aim of the study was to assess the efficacy and safety of temporary placement of FC-SEMS as primary treatment for Type II perforations and review the literature regarding the use of FC-SEMS in this setting.

Patients and method: Retrospective analysis of consecutive patients with Type II perforation treated with immediate placement of FC-SEMS. Primary outcomes were need for surgery and mortality rate. Secondary outcomes were complications, technical and clinical success, time to post-operative feeding, length of the hospitalization and time to stent removal.

Results: Overall, 18 consecutive patients were enrolled (median age 71.5). All patients were treated with FC-SEMS (6–10?mm, 4–8?cm long). In all patients, there were no need for surgery, and no patient died. Technical and clinical success were achieved both in 100% of cases. The median time to stent removal was 43 (2–105) days. The median hospital stay was of 10 (4–21) days. Median time to post-operative feeding was 4 days (2–15).

Conclusion: FC-SEMS placement could be a safe and effective treatment in Type II perforations and represent a valuable development and innovation of conservative treatment.     

Air leak syndrome after endoscopic retrograde cholangiopancreatography: A rare and fatal complication

Endoscopic retrograde cholangiopancreatography (ERCP) is a state of the art diagnostic and therapeutic procedure for various pancreatic and biliary problems. In spite of the well-established safety of the procedure, there is still a risk of complications such as pancreatitis, cholangitis, bleeding and perforation. Air leak syndrome has rarely been reported in association with ERCP and the optimal management of this serious condition can be difficult to establish. Our group successfully managed a case of air leak syndrome following ERCP which was caused by a 3cm Stapfer type I perforation in the posterolateral aspect of the second part of the duodenum and was repaired surgically. Hereby, we describe the presentation and subsequent therapeutic approach.     

Management of perforation after endoscopic retrograde cholangiopancreatography (ERCP): a population-based review

Background. Perforation related to endoscopic retrograde cholangiopancreatography (ERCP) is a rare complication associated with significant morbidity and mortality. This study evaluated the management and outcomes of these perforations. Patients and methods. Between July 1996 and December 2002, a total of 6620 ERCPs were performed at our regional endoscopy unit serving the 1.5 million population of Southern Alberta. Thirty perforations (0.45%) were identified and retrospectively reviewed. Results. Seven of these 30 patients were found to have guidewire perforations of the bile duct, 11 perforations were peri-ampullary, 3 duodenal, 1 esophageal, and 1 patient had a perforation of an afferent limb of a Billroth II anastomosis. In seven patients the location of the perforation could not be determined (unknown). All patients with guidewire perforations were recognized during ERCP, and all were managed medically. Of the 11 peri-ampullary perforations, 7 of these patients had a pre-cut sphincterotomy, 5 underwent surgery and 4 patients died. Delay in diagnosis occurred in all patients that died. Of the three duodenal perforations, all required operation and one patient died. Of the seven ‘unknown’ retroperitoneal perforations, two patients required surgery and there was no mortality. The patients with esophageal and afferent limb perforations both recovered uneventfully after surgery. Most patients who required surgery had retroperitoneal fluid seen on CT scanning. Conclusions. We found that most guidewire perforations can be managed medically with little morbidity. Pre-cut sphincterotomy is a risk factor for perforation. Peri-ampullary and duodenal perforations have a high morbidity and mortality rate. In particular, retroperitoneal fluid collections on CT scans, delay in diagnosis and failure of medical therapy requiring salvage surgery are associated with poor outcomes. Early aggressive surgery may improve patient care.     

Clinical outcomes of ERCP-related retroperito-neal perforations

Endoscopic retrograde cholangiopancreatography (ERCP)-related perforations represent rare but often severe conditions. While lesions with intraperitoneal perforation have an almost imperative indication to surgery, whether or not to manage retroperitoneal perforations surgically is still an area of debate. The aim of the present work was to review the available clinical evidence on the operatively and medi-cally treated ERCP-related retroperitoneal perforations. From MEDLINE/PubMed databases 137 patients with retroperito-neal perforation were included from 12 studies that met the selection criteria for data investigation and analysis. Twenty-four patients were treated by prompt surgery; 113 were primarily managed conservatively and about 20% of these patients required surgery subsequently. Overall, the morbid-ity and mortality were 15.4% and 6.6%, respectively. Although most patients with retroperitoneal perforation may benefit from a non-operative management, a considerable number of patients fail to respond to medical treatment and require sur-gery afterwards. Identifying those patients who are at highest risk of poor outcome after conservative treatment should be considered a research priority.     

Small bowel perforation from a migrated biliary stent:A case report and review of literature

BACKGROUND Bowel perforation from biliary stent migration is a serious potential complication of biliary stents, but fortunately has an incidence of less than 1%.CASE SUMMARY We report a case of a 54-year-old Caucasian woman with a history of Human Immunodeficiency virus with acquired immunodeficiency syndrome, chronic obstructive pulmonary disease, alcoholic liver cirrhosis, portal vein thrombosis and extensive past surgical history who presented with acute abdominal pain and local peritonitis. On further evaluation she was diagnosed with small bowel perforation secondary to migrated biliary stents and underwent exploratory laparotomy with therapeutic intervention.CONCLUSION This case presentation reports on the unusual finding of two migrated biliary stents, with one causing perforation. In addition, we review the relevant literature on migrated stents.