Tarallo M, Crocetti D, Coppola A, Iannone I, Lamazza A, Sapienza P, Fiori E. Endoscopic retrograde cholangiopancreatography-related adverse events: What is the role of surgery today? World J Gastrointest Surg 2025; 17(7): 107385 [DOI: 10.4240/wjgs.v17.i7.107385]
Corresponding Author of This Article
Mariarita Tarallo, MD, PhD, Assistant Professor, Department of Surgery, Sapienza University of Rome, Via Giovanni Maria Lancisi, 2, Rome 00161, Italy. mariarita.tarallo@uniroma1.it
Research Domain of This Article
Surgery
Article-Type of This Article
Minireviews
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/
Mariarita Tarallo, Daniele Crocetti, Alessandro Coppola, Immacolata Iannone, Antonietta Lamazza, Paolo Sapienza, Enrico Fiori, Department of Surgery, Sapienza University of Rome, Rome 00161, Italy
Author contributions: Tarallo M contributed to the writing - original draft; Coppola A participated in the formal analysis; Tarallo M and Fiori E contributed to the conceptualization of this study; Tarallo M, Lamazza A, and Sapienza P participated in the methodology of this manuscript; Tarallo M, Crocetti D, Coppola A, Sapienza P, and Fiori E contributed to the writing - review & editing of this manuscript; Crocetti D and Iannone I curated data and contributed to the research; Lamazza A, Sapienza P, and Fiori E contributed to the supervision of this manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mariarita Tarallo, MD, PhD, Assistant Professor, Department of Surgery, Sapienza University of Rome, Via Giovanni Maria Lancisi, 2, Rome 00161, Italy. mariarita.tarallo@uniroma1.it
Received: March 24, 2025 Revised: April 7, 2025 Accepted: May 20, 2025 Published online: July 27, 2025 Processing time: 123 Days and 12.5 Hours
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) plays a vital role in managing biliary and pancreatic diseases but carries a risk of severe complications that may require surgical intervention. This review focuses on the surgical management of key ERCP-related complications: Post-sphincterotomy bleeding, perforations, stent migration-induced perforations, and Dormia basket impaction. Although many complications can be managed endoscopically, surgery remains essential in refractory cases or when less invasive methods fail. Post-sphincterotomy bleeding, although often controlled endoscopically, may necessitate surgical ligation when hemorrhage persists. Perforations, classified by anatomical type, require tailored surgical approaches - primary repair for type I and biliary diversion with defect closure for types II and III. Stent migration-induced perforations, which may lead to peritonitis or abscess formation, often require surgery due to their variable clinical presentation and the lack of standardized management guidelines. Dormia basket impaction, although rare, may require advanced endoscopic techniques or laparoscopic retrieval if conservative measures prove ineffective. Early recognition, multidisciplinary collaboration, and individualized treatment strategies are pivotal in reducing morbidity and mortality. This review underscores evolving surgical approaches, emphasizing the importance of timely, patient-specific decisions to improve outcomes in severe ERCP-related complications.
Core Tip: Surgical management of post-endoscopic retrograde cholangiopancreatography complications remains crucial despite advancements in endoscopic techniques. This review highlights rare but serious adverse events - post-sphincterotomy bleeding, perforation, stent migration, and Dormia basket impaction - emphasizing diagnostic strategies, therapeutic approaches, and surgical interventions when non-operative methods fail. Early recognition and tailored management, guided by the type of complication and the patient’s condition, are essential for improving outcomes. The review offers an updated, practical overview to assist clinicians in managing these challenging scenarios, particularly when surgery becomes the final - but life-saving - resort.
