Journal of Gastrointestinal Surgery

, Volume 15, Issue 12, pp 2211–2217 | Cite as

A Tailored Approach to the Management of Perforations Following Endoscopic Retrograde Cholangiopancreatography and Sphincterotomy

  • Andreas Polydorou
  • Antonios VezakisEmail author
  • Georgios Fragulidis
  • Demetrios Katsarelias
  • Constantinos Vagianos
  • Georgios Polymeneas
Original Article



The management of endoscopic retrograde cholangiopancreatography (ERCP)-related perforations remains controversial. Τhe aim of the study was to determine the incidence of perforations following ERCP, their characteristics, operative and non-operative management options and clinical outcome.


A retrospective review of ERCP-related perforations, during a 21-year period, was performed. Each perforation was categorized into types I to IV according to the location, mechanism and radiographic evaluation of the injury. Comparisons were made between patients treated operatively and non-operatively.


Forty-four perforations (0.4%) occurred in 9,880 procedures. They were mainly caused by the passage of the endoscope (type I) in 7 (16%) and sphincterotomy (type II) in 30 (68%) patients. The management was non-operative in 32 (72%) and operative in 12 patients. In multivariate analysis, only the type of perforation (type I: endoscope-related) was found significant for predicting operative treatment. The hospital stay was longer for patients requiring an operation (median, 24 vs 9 days). The overall mortality was 2/44 (4.5%). There was no death in the non-operative group.


The need for immediate operative intervention should be based on the type of injury and clinical findings. Patients with type I perforations should be treated surgically and primary repair should be tried. Patients with type II injuries may be treated initially non-operatively. Delayed operative intervention will be required in a minority of these patients.


ERCP Endoscopic sphincterotomy Complications Perforation Management 



Drs. Andreas Polydorou, Antonios Vezakis, Georgios Fraguludis, Demetrios Katsarelias, Constantinos Vagianos, and Georgios Polymeneas have no conflicts of interest or financial ties to disclose.


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Copyright information

© The Society for Surgery of the Alimentary Tract 2011

Authors and Affiliations

  • Andreas Polydorou
    • 1
  • Antonios Vezakis
    • 1
    Email author
  • Georgios Fragulidis
    • 1
  • Demetrios Katsarelias
    • 2
  • Constantinos Vagianos
    • 3
  • Georgios Polymeneas
    • 1
  1. 1.University of Athens, Aretaieion HospitalAthensGreece
  2. 2.Mediterraneo HospitalAthensGreece
  3. 3.Nikea General HospitalAthensGreece

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