P2892 - The Use of Fully Covered Metal Stent Placement for the Management of Sphincterotomy Related Perforations During ERCP: A Comprehensive Review of the Available Literature

Khalid Ahmed, MD¹, Mohamed Abdallah, MD², Ayman Elawad, MD³, Peter Iskander, MD⁴, Manasik Abdu, MD⁵, Osama Hamid, MD, MRCPI⁶, Mouhand FH. Mohamed, MD⁷, Fouad Jaber, MD⁸, Natalie Wilson, MD², Abubaker Abdalla, MD⁹, Khaled Elfert, MD¹⁰, Tessa Herman, MD², Mohammad Bilal, MD^11
1The Wright Center for GME, Scranton, PA; ²University of Minnesota, Minneapolis, MN; ³Howard University Hospital, Washington, DC; ⁴The Wright Center for GME, Dunmore, PA; ⁵University at Buffalo-Catholic Health System, Buffalo, NY; ⁶Cleveland Clinic, Cleveland, OH; ⁷Brown University, Providence, RI; ⁸University of Missouri-Kansas City, Kansas City, MO; ⁹Emory University, Atlanta, GA; ¹⁰SBH Health System, Bronx, NY; ¹¹Minneapolis VA Medical Center, Minneapolis, MN

Introduction: Perforations are uncommon but serious adverse events during endoscopic retrograde cholangiopancreatography (ERCP). Fully covered self-expanding metal stents (FCSEMS) have emerged as a promising treatment option for managing sphincterotomy related perforations during ERCP. We conducted a comprehensive review of the available literature to evaluate the efficacy and safety of FCSEMS in managing sphincterotomy related perforations during ERCP.

Methods: We conducted a systematic literature review of PubMed and EMBASE until March 2023 to identify studies investigating the outcomes of FCSEMS placement in the management of sphincterotomy related perforations. Included studies comprised of prospective and retrospective studies, case series, and case reports. A pooled analysis was performed to summarize baseline characteristics and outcomes, including technical success (defined as successful placement of the FCSEMS), clinical success (defined resolution of the perforation), the need for additional interventions, and adverse events.

Results: A total of 105 patients from 12 studies were included (Table 1). Stapfer classification of perforations was mentioned in 7 studies (86 patients). All patients had type 2 perforation except one patient who had type 3 perforation. The timing of diagnosis of perforation was reported in 11 studies, with 78.5% (73/93) of cases diagnosed intra-procedure and 21.5% (20/93) diagnosed post-procedure. Fluoroscopy was used in 72% (67/93) of cases for diagnosis, while CT scan identified the remaining 28% (26/93). Deployment of stent at index ERCP was performed in 75.2% (79/105) of patients and repeat ERCP with stent placement was performed in the remainder of cases. Additional endoscopic intervention was performed in 12 patients reported from 1 study, involving the deployment of at least two clips. Technical and clinical success rates were 100% and 98.1%, respectively. Surgical intervention was required for two, while three underwent percutaneous drainage. Pancreatitis was reported in 10.5% of the cases. 7.6% developed a fever, 1.9% with bleeding, and 0.95% developed an abscess. One mortality was reported due to sepsis.

Discussion: Our findings suggest that FCSEMS is an effective tool for management for sphincterotomy related perforations during ERCP with an acceptable safety profile. However, our analysis is limited by the inclusion of small retrospective studies and larger studies are needed to validate these findings.


Disclosures:


Khalid Ahmed, MD¹, Mohamed Abdallah, MD², Ayman Elawad, MD³, Peter Iskander, MD⁴, Manasik Abdu, MD⁵, Osama Hamid, MD, MRCPI⁶, Mouhand FH. Mohamed, MD⁷, Fouad Jaber, MD⁸, Natalie Wilson, MD², Abubaker Abdalla, MD⁹, Khaled Elfert, MD¹⁰, Tessa Herman, MD², Mohammad Bilal, MD¹¹. P2892 - The Use of Fully Covered Metal Stent Placement for the Management of Sphincterotomy Related Perforations During ERCP: A Comprehensive Review of the Available Literature, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.