ERCP-induced duodenal perforation successfully treated with endoscopic purse-string suture: a case report

// Quanpeng Li 1, * , Jie Ji 2, * , Fei Wang 1 , Xianxiu Ge 1 , Junjie Nie 1 , Boming Xu 1 , Xiuhua Zhang 1 , Guobing Jiang 1 , Lin Miao 1 1 Medical Center for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China 2 Liver Transplantation Center of the First Affiliated Hospital and State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, Jiangsu Province, China * These authors have contributed equally to this work Correspondence to: Lin Miao, e-mail: miaolinxh@163.com Keywords: duodenal perforation, endoscopic purse-string suture, endoscopic retrograde cholangiopancreatography Received: March 20, 2015      Accepted: May 26, 2015      Published: June 08, 2015 ABSTRACT Duodenal perforation is one of the most serious complications of endoscopic retrograde cholangiopancreatography (ERCP) and is difficult to manage. Recently, endoscopic purse-string suture, using endoloops with endoclips, is a relatively new technology and has provided good clinical results. However, the study and use of endoscopic purse-string suture on duodenal perforation is less and its feasibility and safety are unknown. Here, we report a case of ERCP-induced duodenal perforation successfully treated with endoscopic purse-string suture. During ERCP, fluoroscopy revealed abnormal perinephric gas shadowing after breaking and extracting the stones with a stone-removal basket. Then duodenal endoscopy showed an approximately 2.0 cm × 1.5 cm perforation on the lateral duodenal wall, with visible retroperitoneal loose connective tissue. Titanium clips were used to attempt closure of the perforation but failed because of the long diameter of the injury. Therefore, an endoscopic purse-string suture, using endoloops with endoclips, was employed with an Olympus double-lumen endoscope. The perforation was successfully closed. At the 2-month follow-up visit, the patient had no complaints or symptoms. Our case once again proved its feasibility and safety and provided a new perspective for surgeons.