Surgical versus non-operative initial management of post-endoscopic retrograde cholangiopancreatography perforation: a systematic review and meta-analysis

Athina A. Samara; Alexandros Diamantis; Konstantinos Perivoliotis; Georgios Mavrovounis; Dimitrios Symeonidis; Ioannis Baloyiannis; Dimitris Zacharoulis; Dimitris Zacharoulis

Authors Athina A. Samara, Alexandros Diamantis, Konstantinos Perivoliotis, Georgios Mavrovounis, Dimitrios Symeonidis, Ioannis Baloyiannis, Dimitris Zacharoulis, Dimitris Zacharoulis.

Abstract

Background In the present study we performed a systematic review and meta-analysis regarding the initial management of perforations following endoscopic retrograde cholangiopancreatography (ERCP).

Method A systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Cochrane Handbook for Systematic Reviews of Interventions.

Result In total, 10 comparative studies and 223 patients with post-ERCP perforations were included in the present study. In type I and II perforations, the success rate of initial surgical management was higher compared to the non-operative management (NOM) group (P=0.09 and P=0.02, respectively). There was no statistically significant difference in mortality rates or length of hospital stay between initial surgical and NOM management for any type of perforation.

Conclusions The current meta-analysis demonstrated the significance of the initial management of patients with post-ERCP perforations. Whether a surgical or an endoscopic approach is chosen, the patient should immediately be evaluated by an experienced surgeon or endoscopist.

Keywords Endoscopic retrograde cholangiopancreatography, complications, duodenal perforation, surgical management, iatrogenic duodenal injury

Ann Gastroenterol 2022; 35 (1): 95-101