Comparison of Early and Delayed Diagnosis on Mortality in ERCP Perforations: A High-Volume Patient Experience
| Autor: | Buğra Tolga Konduk, Ersin Borazan |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Delayed Diagnosis Delayed diagnosis Sepsis Young Adult Postoperative Complications Patient experience Humans Medicine Intraoperative Complications Aged Retrospective Studies Aged 80 and over Cholangiopancreatography Endoscopic Retrograde Endoscopic retrograde cholangiopancreatography medicine.diagnostic_test business.industry Mortality rate Retrospective cohort study Middle Aged medicine.disease Surgery Anesthesiology and Pain Medicine Intestinal Perforation Acute abdomen Emergency Medicine Female medicine.symptom Complication business |
| Zdroj: | Turkish Journal of Trauma and Emergency Surgery. |
| ISSN: | 1306-696X |
| Popis: | Background Although ERCP (Endoscopic retrograde cholangiopancreatography) perforation is a rare complication, it results in high morbidity and mortality. In this study, clinical evaluation was performed concerning the incidence, clinical data and time of diagnosis for ERCP perforations that were either surgically or medically treated. To reduce the ERCP perforations and related mortality, in this study, we aimed to reveal the clinical features and compare them with the literature. Methods In this clinical retrospective study, 51 perforations were detected in 8676 ERCP procedures performed in the past eight years in our hospital. We compared the two groups: early diagnosed patients [Group 1: n=40] and the delayed diagnosed patients [Group 2: n=11] concerning primary diagnosis, blood and biochemical tests before ERCP, perforation type, treatment method, clinical features, length of stay, and mortality. These groups were compared concerning stent placement, papillotomy choledochal dilatation and the number of ERCP procedures. Results The ERCP perforation rate in our hospital was 0.59%. The majority of patients who underwent ERCP procedures was due to the choledocholithiasis and periampullary tumors. The mean age was 62.78±17.13 (24-89 years old) and 56.9% of the patients (n=29) were women. Stapfer type II perforations (49%) were the most common type of perforation. However, 62.5% of the total mortality occurred in patients with type I perforation. The overall mortality rate was 13.72% (n=7). The duration of hospitalization (13.38±10.09 days) was higher in the patients who were treated surgically (n=24). Choledochal stents were utilized mostly in the medically treated patients (74.1%) (p=0.039). The patients in Group 1 were detected visually by the operator during the ERCP by leakage of contrast substance (13/40) or by abdominal tomography due to clinical suspicion. Patients in Group 2 had higher pre-ERCP leukocyte levels (p=0.044). The urgent surgery requirement in Group 2 was 72.7%, while the mortality rate was 36.4%. Significant mortality difference was observed between the early and late detection of perforations, indicating a higher rate in Group 2 (p=0.014). Conclusion In the patients who were diagnosed early, fewer surgical interventions were required, except for the type I perforations. Type II perforations can often be safely treated non-surgically if there are no signs of acute abdomen and sepsis. Early diagnosis and treatment significantly reduce ERCP-related mortality. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|