Successful endoscopic closure by over-the-scope-clip for ERCP-induced type I duodenal perforation

ERCP-related adverse events are observed more frequently compared with other endoscopic procedures. Among others, lateral wall perforation of the duodenum is often serious and can even be fatal. A 78-year-old female was diagnosed with choledocholithiasis. We planned ERCP procedure for stone retrieval, but it was quite difficult to insert the scope into the duodenum. After several attempts, a duodenal lateral wall was injured with a tip of the duodenoscope while advancing the endoscope. Fat tissue was confirmed beyond the perforation site, suggesting that ERCP-related perforation occurred. Then, endoscopic closure with over-the-scope clip (OTSC) was attempted to close the duodenal wall defect. The procedure was successfully performed. Subsequent duodenography did not show leakage of contrast agent outside the duodenal wall. No fluid collection or gas was observed on any of the CT following endoscopic closure and his clinical course was uneventful. We herein report a case underwent successful endoscopic closure with OTSC, helped avoid surgery.