ERCP-Related Perforations

  • Alberto TringaliEmail author
  • Marcello Cintolo
  • Massimiliano Mutignani


Perforations are threatening adverse events during ERCP, with an incidence ranging between 0.08 and 2.2% of the procedures, varying among the different series. ERCP-related perforations are divided into four groups according to Stapfer’s classification: type 1 (duodenal wall), type 2 (periampullary), type 3 (biliary duct), and type 4 (only free air at the CT scan). Many risk factors (RF) have been reported for ERCP-related perforations; most important RFs are surgically altered anatomy, for type 1, and sphincterotomy, use of guidewires, and biliary or papillary dilation, for type 2 and 3. The immediate recognition of the perforation at the endoscopy or at the fluoroscopy is crucial to achieve better outcomes and for a timely treatment. Post-procedural diagnosis of perforation is usually, clinically suspected, and subsequently confirmed by abdominal CT scan. A prompt endoscopic closure of type 1 perforation should be attempted; otherwise surgery is strongly recommended. In type 2 and 3 perforations, conservative management is appropriate, although the endoscopic immediate placement of FCSEMS seems to be indicated to achieve better outcomes and to avoid subsequent surgery with prolonged hospital stay and high morbidity and mortality.


ERCP Duodenal perforation Retroperitoneal perforation Sphincterotomy Stapfer’s classification 





Biliary stent


Conservative treatment


Common bile duct


Case report


Case series


Computed tomography




Endoscopic band ligation


Endoscopic retrograde cholangiopancreatography


Fully covered self-expandable metal stent




Naso-biliary drainage




Naso-duodenal tube


Nasogastric tube


Number not reported


Not reported


Over-the-scope clip


Plastic biliary stent


Percutaneous drainage (surgical)


Percutaneous transhepatic cholangiography






Through-the-scope clip


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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Alberto Tringali
    • 1
    • 2
    Email author
  • Marcello Cintolo
    • 3
  • Massimiliano Mutignani
    • 3
  1. 1.Endoscopy UnitASST Grande Ospedale Metropolitano NiguardaMilanItaly
  2. 2.ULSS 2 Marca Trevigiana, Conegliano HospitalConeglianoItaly
  3. 3.Endoscopy UnitASST Grande Ospedale Metropolitano NiguardaMilanItaly

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