Dieninyte E, Pliuskute K, Jarasunas J, Stanaitis J, Poskus T. Endoscopic retrograde cholangiopancreatography associated perforations: 10-year experience of a large volume center. World J Gastrointest Endosc 2026; 18(4): 118361 [DOI: 10.4253/wjge.v18.i4.118361]
Corresponding Author of This Article
Egle Dieninyte, Doctorate Student, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Ciurlionio g. 21, Vilnius 03101, Lithuania. egle.dieninyte-misiune@mf.vu.lt
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. Apr 16, 2026; 18(4): 118361 Published online Apr 16, 2026. doi: 10.4253/wjge.v18.i4.118361
Endoscopic retrograde cholangiopancreatography associated perforations: 10-year experience of a large volume center
Egle Dieninyte, Kamile Pliuskute, Juozas Jarasunas, Juozas Stanaitis, Tomas Poskus
Egle Dieninyte, Juozas Stanaitis, Tomas Poskus, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius 03101, Lithuania
Egle Dieninyte, Juozas Stanaitis, Department of Endoscopic Diagnostics and Minimally Invasive Surgery, Vilnius University Hospital Santaros Klinikos, Vilnius 08406, Lithuania
Kamile Pliuskute, Tomas Poskus, Center of Abdominal Surgery, Vilnius University hospital Santaros Klinikos, Vilnius 08406, Lithuania
Juozas Jarasunas, Department of Radiology, Vilnius University Hospital Santaros Klinikos, Vilnius 08406, Lithuania
Author contributions: Dieninyte E, Pliuskute K, Poskus T, Stanaitis J participated in the conception and design of the study and were involved in the analysis and interpretation of data; Dieninyte E wrote the manuscript; Dieninyte E and Pliuskute K accessed and verified the study data, Jarasunas J provided images and critical appraisal of diagnostic features.
Institutional review board statement: Permission by the Vilnius regional Bioethics Committee for the study was obtained (No. 2023/10-1539-1006). The study was conducted in accordance with the principles of the Declaration of Helsinki.
Informed consent statement: Vilnius regional bioethics committee granted permission to conduct the post hoc analysis without additional informed consent.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: No additional data are available.
Corresponding author: Egle Dieninyte, Doctorate Student, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Ciurlionio g. 21, Vilnius 03101, Lithuania. egle.dieninyte-misiune@mf.vu.lt
Received: December 30, 2025 Revised: January 21, 2026 Accepted: February 11, 2026 Published online: April 16, 2026 Processing time: 104 Days and 11.3 Hours
Abstract
BACKGROUND
Endoscopic retrograde cholangiopancreatography (ERCP) is a crucial treatment modality for biliary and pancreatic obstruction carrying significant technical challenges and high complication rate. Although rare, complication of perforation can lead to significant morbidity and mortality if not promptly recognized and managed appropriately.
AIM
To investigate the incidence, patterns of diagnosis and management and outcomes of ERCP associated perforations.
METHODS
This study is a post-hoc analysis of a prospectively collected database of ERCP procedures carried out in a referral center in Lithuania between 2010 and 2019.
RESULTS
In the period between 2010 and 2019 years 5462 ERCP procedures were performed. 2665 ERCP procedures were carried out with an intention of biliary stent placement resulting in 20 perforations (0.75%). The average age of patients with ERCP associated perforations was 73.2 ± 11.9 years, 7 of them being male (35%). The complication was diagnosed intra-procedurally in 6 patients (30%) and perforations most often occurred in biliary tract (n = 8, 40%). Half of the patients with diagnosed ERCP associated perforation underwent surgical interventions (n = 10, 50%). Median duration of hospitalization for patients with ERCP associated perforations was 16.5 days and a quarter of the patients died (n = 5, 25%).
CONCLUSION
ERCP associated perforation is a rare but potentially fatal procedural complication, necessitating prompt diagnosis, thorough workup and a multidisciplinary management plan.
Core Tip: Endoscopic retrograde cholangiopancreatography (ERCP) is a mainstay minimally invasive treatment modality for biliary and pancreatic duct obstruction. Despite rapid advances in endoscopic techniques ERCP remains one of the most complication-prone interventions. Although rare, ERCP associated perforations can lead to significant morbidity and mortality if not promptly recognized and managed appropriately. This article provides detailed insight into the diagnostic and clinical pathways of managing ERCP associated perforations in a high-volume center, crucial decision-making aspects and promising facets to consider for improved patient outcomes. The results underpin the significance of prompt diagnosis and the importance of multidisciplinary approach when managing ERCP associated perforations.
