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Post-ERCP perforation

Andrea Tringali, MD, PhD
Silvano Loperfido, MD
Guido Costamagna, MD, FACG
Section Editor
Douglas A Howell, MD, FASGE, FACG
Deputy Editor
Kristen M Robson, MD, MBA, FACG


Perforation is one of the most feared complications of endoscopic retrograde cholangiopancreatography (ERCP). This topic review will focus on the risk factors, diagnosis, and treatment of post-ERCP perforation. An overview of the complications of ERCP and detailed discussions of other individual complications are presented separately. (See "Endoscopic retrograde cholangiopancreatography: Indications, patient preparation, and complications" and "Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis" and "Post-endoscopic retrograde cholangiopancreatography (ERCP) bleeding" and "Rare complications of endoscopic retrograde cholangiopancreatography (ERCP)".)


Four types of perforation complicating endoscopic retrograde cholangiopancreatography (ERCP) have been recognized [1,2]. The Stapfer classification is most commonly used and is based on the mechanism, anatomical location, and severity of the injury that may predict the need for surgical intervention (figure 1) [2]:

Type I: Free bowel wall perforation

Type II: Retroperitoneal duodenal perforation secondary to periampullary injury

Type III: Perforation of the pancreatic or bile duct

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Literature review current through: Nov 2017. | This topic last updated: Nov 16, 2017.
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