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World J Gastrointest Endosc. Oct 10, 2015; 7(14): 1135-1141
Published online Oct 10, 2015. doi: 10.4253/wjge.v7.i14.1135
Endoscopic retrograde cholangiopancreatography-related perforations: Diagnosis and management
Antonios Vezakis, Georgios Fragulidis, Andreas Polydorou
Antonios Vezakis, Georgios Fragulidis, Andreas Polydorou, Academic Department of Surgery and Endoscopy Unit, University of Athens, Aretaieion Hospital, 11528 Athens, Greece
Author contributions: Vezakis A, Fragulidis G and Polydorou A equally contributed to conception and design, acquisition of data, drafting, revision and final approval of the article.
Conflict-of-interest statement: No author has conflict of interest related to the manuscript.
Open-Access: 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/
Correspondence to: Antonios Vezakis, Assistant Professor of Surgery, Academic Department of Surgery and Endoscopy Unit, University of Athens, Aretaieion Hospital, 76 Vas. Sofias Ave., Athens 11528, Greece. avezakis@hotmail.com
Telephone: +30-210-7286152 Fax: +30-213-0270352
Received: April 27, 2015
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

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.