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ERCP-related perforation: an analysis of operative outcomes in a large series over 12 years

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Perforation is a rare but serious adverse event of endoscopic retrograde cholangiopancreatography (ERCP). The aim of this study was to determine the predictors of morbidity and mortality after surgical management of ERCP-related perforation (EP).


The records of patients with EP requiring surgical intervention at a tertiary referral center in a 12-year period (2004–2016) were retrospectively analyzed for demography, indications for ERCP, risk factors, timing and type of surgical repair, post-operative course, hospital stay, and outcome. Multiple logistic regression was used to identify the parameters predicting survival.


Of 25,300 ERCPs, 380 (1.5%) had EP. Non-operative management was successful in 330 (86.8%) patients. 50 (13.2%) patients were operated for EP. Out of 50, the perforation was detected during ERCP (intra-procedure) in 32 patients (64%). In 30 patients (60%), the surgery was performed within 24 h of ERCP. Twenty patients underwent delayed surgery (after 24 h of ERCP) following the failure of initial non-operative management. The delayed surgery after an unsuccessful medical treatment had a detrimental effect on morbidity, mortality and hospital stay. Post-operative duodenal leak was the only independent predictor of 90-day mortality (p = 0.02, OR = 9.1, 95% CI 1.52–54.64). Addition of T-tube duodenostomy (TTD) to the primary repair for either type I or type II perforations increased post-operative duodenal leak (type I, p = 0.048 and type II; p = 0.001) and mortality (type I, p = 0.009 and type II, p = 0.045).


Although EP is a rare event, it has a serious impact on morbidity and mortality. Delaying of surgery following failed non-operative management worsens the prognosis. Addition of TTD to the repair is not helpful in these patients.

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All authors listed above made substantial contributions to the conception and design of this study, have revised its intellectual content, and have approved of the final submitted version.

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Correspondence to Nilesh Sadashiv Patil.

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The authors Nilesh Patil, Nisha Solanki, Pramod Kumar Mishra, Barjesh Chander Sharma, and Sundeep Singh Saluja have no conflicts of interest or financial ties to disclose.

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Patil, N.S., Solanki, N., Mishra, P.K. et al. ERCP-related perforation: an analysis of operative outcomes in a large series over 12 years. Surg Endosc 34, 77–87 (2020).

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