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Iatrogenic perforation of the duodenum during endoscopic retrograde cholangiopancreatography (ERCP) is a rare but serious complication. Very few cases of endoscopic vacuum therapy (EVT) of duodenal leakages have been reported [1,2]. We developed a new, open-pore film drainage (OFD) technique, which allows the diameter of the drainage tip to be minimized [3]. The distal end of a drainage tube (Ventrol, 12Fr×120cm; Covidien Argyle, Dublin, Ireland) is wrapped in a very thin, open-pore, double-layered drainage film (Suprasorb CNP, Drainage Film; Lohmann & Rauscher International GmbH & Co. KG, Rengsdorf, Germany) and secured using a suture (●" Fig.1). The placement procedure for the OFD tube in the duodenal lumen is the same as for intestinal feeding tubes. The small diameter of the OFD device allows placement through small openings. The OFD tube is inserted nasally (●" Fig.2), and then the tip of the OFD tube is grasped by forceps (●" Fig.3) and pushed forward into the duodenal lumen under endoscopic view (●" Fig.4). The OFD tube can also be placed Fig.1 New, open-pore film drainage (OFD) device. aMaterial used to construct the OFD device: tube (T), open pore film (F), and suture (S). b The tube (T) was wrapped in open-pore film (F), which was fixed in place with the suture (S); the tip of the tube has lateral perforations (lP). c The OFD, endoscope (E), and grasper (G).

Successful endoscopic vacuum therapy with new open-pore film drainage in a case of iatrogenic duodenal perforation during ERCP