Interventional three-tube method for the management of duodenal perforation after endoscopic retrograde cholangiopancreatography for choledocholithiasis: a case series

Endoscopic retrograde cholangiopancreatography (ERCP) is a common procedure for biliary and pancreatic diseases. Although duodenal perforation is a rare complication of ERCP (incidence, <1%), it is associated with a significant mortality rate (4.2-37%). The existing evidence for the management of retroperitoneal abscess or sepsis is limited, since conservative treatments are often ineffective and surgical outcomes are poor. Endoscopic repair is particularly challenging for large perforations, with failure rates of up to 78%. This study reviews seven cases of post-ERCP duodenal perforation treated with an interventional three-tube method. This retrospective study reviewed seven cases showing duodenal perforation after ERCP for choledocholithiasis between 2019 and 2024. The patients showed clinical symptoms such as fever, abdominal pain, and abdominal distension within 1-3 days after ERCP, and were managed with the interventional three-tube method (insertion of a nasointestinal feeding tube for enteral nutrition, a gastrointestinal decompression tube, and a percutaneous drainage tube for drainage of pus and air). After 5-7 days of hospitalization, the patients were discharged upon stabilization. All patients showed successful healing of duodenal perforation during follow-up. The interventional three-tube method is an effective method for treating duodenal perforations following ERCP, offering a less invasive alternative for this type of complication.