Abstract

Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) is a frequently performed invasive procedure associated with serious complications. While the rate of ERCP-related perforation is approximately 1%, the associated mortality rate can be as high as 8%. These perforations are categorized based on the Stapfer classification. Type I refers to duodenal perforations, Type II to periampullary perforations, Type III to perforations of the biliary system or pancreatic duct, and Type IV to the presence of retroperitoneal free air.

Methods: In our retrospective study, we analyzed patients who were consulted for post-ERCP perforation at our clinic over a five-year period. Treatment decisions were made jointly by the performing gastroenterologist and an experienced hepatobiliary surgeon. Conservative management included nil per os (NPO), close monitoring of laboratory and physical examination findings, and administration of intravenous fluids and antibiotics.

Results: A total of 35 patients were included in the study. The mean follow-up period was 12.7 days. Six patients who were clinically and biochemically unstable underwent surgery; two of these had Type I perforations and four had Type II perforations. Of the 29 patients managed conservatively, 26 were discharged in good health.

Conclusion: The necessity for surgical intervention in patients with post-ERCP perforation is a critical determinant of prognosis. The requirement for surgery and the subsequent high rates of mortality and morbidity in Type I and Type II perforations indicate the need for a more aggressive treatment strategy for these types. Conversely, conservative treatment appears to yield successful outcomes in patients with Type III and Type IV perforations. Therefore, an approach based on the Stapfer classification plays a significant role in the management of these patients.

Keywords: ercp, perforation, stapfer, endoscopy

License

Copyright (c) 2026 The Author(s). This is an open access article distributed under the Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.

How to Cite

1.
Yemez K, Yoldaş M, Atay A, Günay S, Güneş Ö, Cengiz F, et al. Treatment of perforation after endoscopic retrograd cholangiopancreatography. J Trends Med Invest. 2025;1(3):63-9. https://doi.org/10.64512/JTMI.2025.14

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