Published online Oct 10, 2015. doi: 10.4253/wjge.v7.i14.1135
Peer-review started: April 30, 2015
First decision: July 25, 2015
Revised: July 31, 2015
Accepted: September 7, 2015
Article in press: September 8, 2015
Published online: October 10, 2015
Processing time: 175 Days and 6.3 Hours
Core tip: Perforation is one of the most feared complications of endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy. The incidence of ERCP-related perforations is low (0.39%) with an associated mortality of 7.8%. Endoscopic sphincterotomy is responsible for 41% of perforations and endoscope manipulations for 26%. The mechanism, site and extent of injury, suggested by clinical and radiographic findings, should guide towards operative or non-operative management. Classification into types permits a tailored approach to management. Whilst surgery is usually indicated in patients with type I injuries, patients with type II or III injuries should be treated initially non-operatively. A minority of them will finally require surgical intervention.