Management of duodenal and pancreaticobiliary perforations associated with periampullary endoscopic procedures

BACKGROUND: The purpose of this study was to determine the incidence and outcome of pancreaticobiliary and duodenal (PB/D) perforations from periampullary endoscopic procedures and to examine whether clinical indexes are predictive of the need for operative management. METHODS: A retrospective review compared patients who had operative intervention for PB/D perforation with those managed nonoperatively. RESULTS: Thirty-two PB/D perforations occurred in 4,919 procedures (.6%). Twelve (37%) required operation; 20 (63%) were successfully managed nonoperatively. Radiographic imaging was not helpful in predicting the need for operation. A clinical scoring system was predictive of the need for operative management. The length of stay and morbidity rates were higher in the operatively managed patients. CONCLUSIONS: Most endoscopic PB/D perforations can be successfully managed without operation and, clinical indices are most predictive in determining the need for surgery. Further prospective evaluation of this scoring system may help guide the need for and timing of operative intervention for PB/D) perforations. (c) 2008 Published by Elsevier Inc.