Alterations in the management for patients with retroduodenal perforations after transpapillary interventions

Abstract

Aim. To evaluate treatment results of retroduodenal perforations after transpapillary endoscopic procedures, considering new possibilities of modern minimally invasive interventions.Materials and methods. Perforations were identified in 29(0,5%) cases from 5943 endoscopic retrograde procedures in Moscow City Hospital №31 since 01.01.2010 to 01.01.2021. There were 24(82,8 %) women and 5(17,2%) men in the age from 29 to 89 years (median age – 64.2 ± 14.9 years) Endoscopic papillosphincterotomy was performed n 25 (86.2%) cases (in 5 – incisional), with additional lithoextraction in 12 (46.7%), endoscopic papillectomy – in 4 (10%) cases. Perforations developed in 27 (93,1%) patients with two and more risk factors.Results. Combination of endoscopic and conservative treatment was applied to cure the perforation in 24 cases (82.8%). A fully covered self-expandable metal stent was placed in 16 (66.7%) cases, and clips were applied to stenting in 2(8.3%) cases. Isolated endocliping was performed in 5 (20.8%) patients, and a plastic biliary stent – in 1(4.2%) case. Other 5(17.2%) patients underwent conservative (3) and surgical (2) treatment only. Satisfactory results were achieved in 23(79.3%) cases, when combination of endoscopic and conservative therapy was performed. Mortality was observed in 6(20.7%) cases (isolated conservative therapy (3), surgical treatment (2) and endoscopic placement of a plastic biliary stent (1).Conclusion. Retroduodenal perforations can lead to death in 20.7% cases, according to our data. Timely diagnosis and using a combination of conservative and endoscopic methods as biliary stenting with fully covered self-expandable metal stent and endocliping allowed to achieve recovery in all cases.