Immediate detection of endoscopic retrograde cholangiopancreatography-related periampullary perforation: Fluoroscopy or endoscopy?

Table 1 Clinical characteristics of endoscopic retrograde cholangiopancreatography-related perforation cases

No	Age/Sex	Indications	Perforation site	Type	Mechanisms of perforation	Insufflation	Detection (Time in minutes)	Diagnostic modality	Management	Length of hospital stay after perforation, in days
1	70/M	CBD stone	Afferent loop (Billroth-II)	I	Endoscope	Room air	Immediate (0)	Endoscope	Immediate surgery	16
2	84/F	CBD stone	Periampullary	II	EST	Room air	Immediate (15)	Fluoroscope	Surgery	56
3	97/F	CBD stone	Periampullary	III	Endoscopic instrument	Room air	Immediate (46)	Fluoroscope	ERBD	64
4	70/F	CBD stone	Periampullary	II	EST/EPBD	CO2	Immediate (20)	Fluoroscope	Surgery	41
5	57/M	CBD stone	Periampullary	II	EST	CO2	Immediate (4)	Fluoroscope	ENBD	13
6	90/F	CBD stone	Periampullary	II	EPLBD	CO2	Immediate (3)	Fluoroscope	ENBD	22

CBD: Common bile duct; ENBD: Endoscopic nasobiliary drainage; EPBD: Endoscopic papillary balloon dilation; EPLBD: Endoscopic papillary large-balloon dilation; ERBD: Endoscopic retrograde biliary drainage; EST: Endoscopic sphincterotomy.

Table 2 Previously reported rates of endoscopic sphincterotomy-related perforation, mortality, surgery required, and immediate/early detection

Ref.	Publication year	Total perforation rate, %	EST-related perforation
			Rate, %	Surgery, %	Mortality, %	Immediate/early diagnosis, %
Cotton et al[1]	1991	NR	1.30	26.8	16.3	NR
Loperfido et al[2]	1998	1.01	0.43	50.0	8.3	NR
Howard et al[3]	1999	0.60	0.36	4.5	4.5	90.9
Stapfer et al[4]	2000	1.00	0.42	50.0	0	66.7
Masci et al[10]	2001	0.64	0.57	36.0	NR	NR
Enns et al[5]	2002	0.35	0.14	15.4	0	76.9
Christensen et al[11]	2004	1.27	0.85	NR	10.0	100
Wu et al[12]	2006	0.45	0.17	45.0	36.0	36.0
Fatima et al[13]	2007	0.60	0.09	36.4	NR	NR
Assalia et al[7]	2007	0.71	0.55	11.8	5.9	94.1
Kapral et al[14]	2008	0.50	0.38	8.3	8.3	NR
Morgan et al[8]	2009	0.20	0.10	0	0	66.7
Cotton et al[15]	2009	0.14	0.03	75.0	0	NR
Shi et al[23]	2009	NR	0.26	NR	NR	NR
Kim et al[9]	2009	0.89	0.40	11.1	0	NR
Kim et al[16]	2011	0.16	0.07	60.0	0	60.0
Polydorou et al[17]	2011	0.40	0.30	20.0	0	96.7
Kwon et al[18]	2012	0.63	0.29	3.1	3.1	70.0
Li et al[19]	2012	0.19	0.11	0	0	100
Kim et al[20]	2012	0.62	0.23	NR	NR	NR
Average		0.58	0.35	26.7	5.15	78.0

EST: Endoscopic sphincterotomy; NR: Not reported.