Endoscopic Band Ligation in Endoscopic Retrograde Cholangiopancreatography Related Duodenal Perforation

Although ERCP is a therapeutic endoscopic procedure in pacreatico-biliary diseases, its rare complications, including pancreatitis, duodenal perforation, and bleeding, can be fatal. An 87-year-old woman with a history of gallbladder cancer presented with jaundice and general weakness. Her skin color was yellowish and epigastric tenderness was confirmed on a physical examination. On abdomen CT, the gallbladder cancer directly invaded the duodenum, common bile duct, and liver parenchyma. Enlarged portocaval lymph nodes obstructed the extrahepatic bile duct. ERCP was performed for bile duct decompression. When shortening of endoscopy was achieved, the duodenal lateral wall was perforated because of the endoscopic tip pressure. After inserting endoscopic retrograde biliary drainage and endoscopic nasobiliary drainage, endoclips were placed evenly around the defect, and a detachable snare was tightened around the endoclips. Three days later, the duodenal wall was not sealed on the abdomen CT scan. Repeat endoscopy was achieved, and the endoscopic nasobiliary drainage, endoscopic retrograde biliary drainage, endoclips, and detachable snare were removed. From the distal margin of the perforation, band ligation was performed, and a detachable snare was applied. The patient's condition improved after the second procedure. A percutaneous biliary stent was inserted, and she was discharged. This case highlights the successful endoscopic management of ERCP-related duodenal perforation. (Korean J Gastroenterol 2021;77: 136-140)